That is sustainable over time. I think those are all vague rings, im not a policy person. Im looking at how these things spread and what are the approaches we can take to empower communities to come up with their own solutions. Do we ask them, what you think we should do . And they said what i think we should have bed nights, no they dont, we they say we would like better water into this town or whatever it is. Thank you. Im from a part of this world where this has impacted me but nonetheless im talking about the care being and they have a huge problem because of the poverty and marginalization. Im happy that you talked about the fact that Public Health issue and sanitation issue basically are more important than medical issues for stopping a lot of stuff from happening. Two questions, the first, because we have not talked about that but i know both from europe and from the United States of america and other developed countries there are attempts to place people in the tropics in different places, africa for example, try to figure out potentially and how to potentially track those things. That is the first thing maybe you want to talk about. The next thing is it zika that is starting to spread and care being. Not my island but its only a matter time before it gets there also. But it is a complex coming out of brazil the whole issue of consequences for kids. People are saying that yes potentially for sought people with genetic profiles you can suffer consequences. It was also seen as a problem no one is talking about that a lot of these neighborhoods where this is happening especially with kids, the consequence for kids are neighborhoods with a lot of pesticides and stuff like that. Is it zika or is it zika plus these other things . Have you heard about that . I would like to hear from you. So that there has been lots of alternate theories about why we have had this rash of microcephaly in brazil. Some of them are easy to say no thats not happening, the pesticide theory to me there is a lot of evidence, its not the best pesticide. Its been used in other parts of the world but has not been a spike in microcephaly. Couldve it it been used differently in these places . Could somehow because of cultural reasons could those people have gotten a higher dose . Or Something Different happened . I do not know. I think it is a mistake to dismiss these alternative conspiracy theories. I think its just to dismiss them and i think that is what and sort of the conventional response especially from the Global Health establishment to say stop spreading these conspiracy theories, but there is a reason why these alternate theories come about. I think its important to look at that. They come about because of a lack of trust in our biomedical establishment. Where does that come from . If you trace that back and this is something i try to do in the book, look at why were Health Workers doing the treadmill and crisis west africa attacked and slaughtered . This happened during cholera epidemics too. There were burned down quarantine hospitals. If you walk it back, there are transgressions that have occurred between the biomedical establishment of local people. Mabel threw the best of intentions but it is still there. It needs to be addressed. That lack of lack of trust needs to be addressed. It is real. When we dismiss peoples alternate theories we are dismissing the altar line feeling that they do not trust and i think it makes it worse. And its the same thing with the anti vaccine argument where people say these people are so stupid and ignorant they do not get the vaccine of course it doesnt cause autism and of course we do, but where does that mistrust come from . People are frightened about industrial contaminants. About chemical contaminants and corporate secrecy. All of these things, corporate control control of medicine, these are all issues worth of dressing and why people feel they cannot trust these messages. We need that, we, we need to do that work now because when some big pandemic comes we really need to do trust our authority. We need to be on the same page, we, we are not there yet, we have a lot of pockets of miss trust and conspiracy theories that come up almost immediately. Within days of the zika virus there is the monsanto, all kinds of theories about why this is happening. Im studying Public Health at George Washington university and Environmental Health and policy. Im taking a a class called the social determinants of health and my question is how would we work toward creating policy that would be effective in investing addressing Environmental Issues and social issues as you mentioned earlier . Thats a huge issue. How do people experience disease and what does that mean about what kind of intervention is going to make sense in their lives. This is a huge issue in malaria which was the topic of my last book where we are hatching a lot to plans to help people in countries that did not necessarily match up with their own priority. Bed nets were a good example of that where we created insecticide treated bed nets it was a great idea because it was cheap, easy, no, no refrigeration, no hospitals, no roads, no anything. These people can be in a poor, deprived setting and we can give them this intervention and it will save them from malaria. Well, okay we did that. Spent a lot of money and sent the nets around and it was a good effort and a lot of resources were spent doing that. Then they were not used right away. 20 were being used, a very low percent. Then they they sent the anthropologist and see what was happening. People do not consider malaria consider disease in their lives, they consider it a normal part of their lives. The nets are hot and square, its the nicest material that theyve had in their huts of their sameness for their honored guest, all kinds of reasons that were not considered. It is because people on the ground who have the most malaria, they think of it in a different way than we think of it. Part of it is immunity. They have immunity to it, if you survive the gauntlets of the first two years of life and have your 12 episode of malaria and survive it you have immunity to it. Malaria comes and goes. It is the way you and i think of the flu. If we had a bunch a bunch of african scientists come over to the United States and say you people will lose 40,000,000,000 dollars a year from cold and flu all you need to do is where this mask when you go to school or work, its so simple. We dont need dont need anything fancy, well just give you all of these were free. Would we do it . We dont even wash her hands during flu season. I have sort of a question a contrast between this book in ted koppels book about doomsday vents like massive power outages. What are your personal actions that you have done to prepare for pandemics or what are you doing your daily life to avoid epidemic disease . I do things, keep up with my vaccinations, wash my hands, i tried to stay informed because each pathogen is different. I do. I do believe we live in a microbial world. Disease is part of our relationship with nature. This idea that we should live in some kind of germfree environment and never have this is really anomalous if you think about through the long history of humankind battle with microbes. We had the first antibiotic in the 19 forties, by 1980s we started having hiv and lyme disease, all of these new pathogens came out that we cannot really treat that well anymore. So that. Of time when we had this sense, and this is a. Of time when i grow up and im the daughter to dr. So so i grew up with that feeling that infection, who cares, ill take anabiotics it simple. I dont need to live with that, thats not going to be part of my life. Well, maybe that was wrong. I think were going to have to adjust to the new reality as anabiotic stop working one by one which is already happening. Thank you so much [applause]. Thank you all. Think it is on if you went mine folding up your own chair and you can get your book signed here. Books are for sale at the front. Thank you. Thank you. [applause]. Thursday night on book to be asked about education. Ed boland is the author of a battle of room 314, my europe hope and despair in a new york city high school. Then the National Association of scholars reports on the assigned reading for Incoming College freshmen. From the tucson festival a book, a discussion of education. Book tv be in prime time, a p. M. Eastern on cspan2. Book to be has 48 hours of nonfiction books and authors every weekend. Here are some programs to watch for. This weekend, join us for the 22nd annual virginia festival of of the book in charlottesville. Starting saturday at noon eastern. Programs include author Bruce Hillman who discusses his book, the the man who stocked einstein. How nazi scientist changed the course of history. Then saturday evening at seven p. M. , Patricia Bell scott, Professor Emeritus of womens studies at the university of georgia on her book, the firebrand and the first lady, portrait of a friendship. Paul murray, Eleanor Roosevelt and the struggle for social justice. The book the book explores the relationship between civil rights activist and first lady Eleanor Roosevelt. Patricia bell scott speaks with author and historian at roosevelt house in new york city. On sunday sunday beginning at 1 00 p. M. Eastern, more from the virginia festival a book, including kelly carlin, George Carlin starter who talks about her life growing up the comedian and her book, a carlin home companion. Sunday night at 9 00 p. M. , afterwards with historian nancy , author of, the making of americas first president. Miss she is interviewed by kim chair and cofounder of cornell law school. For a woman to be at the head of the most powerful country of the world, where one of our key allies have not allowed women to drive and are most significant enemy at this time, isis, is literally executing women and girls simply from being women and girls, i think a sense a powerful message from the bully pulpit about what america stands for. Go to booktv. Org for the complete schedule. For this year student contest students produced documentaries telling us issues they want the candidates to discuss during the campaign. Student slows the economy, equality, education, and immigration were all top issues. Thanks to all of the students and teachers who competed this year and congratulations 12 are winners and every weekday and april starting on first, one of one of the top 21 winning entries will air at 6 50 a. M. Eastern on cspan. All all entries are available for viewing online. Coming up on book tv, books about medicine and healthcare, not, author vincent davida on Cancer Research. Then Jeffrey Lieber meant the author of strings, the untold story of psychiatry. In the author a pandemic, sonja shaw on how to prevent the spread of infectious disease. Doctor vincent davida and his daughter elizabeth davida rayburn are coauthors of the death of cancer, the history of Cancer Research and the development of cancer therapies. They discussed cancer treatments including chemotherapy, immunotherapy and medical marijuana. This is onece hour. Good evening everybody. I am the Program Director here at the west Court Library and im pleased to welcome you to this evenings program. Program di just a few housekeeping items before we get started, if you could please take a moment to silence yourself on, youve noticed a few cameras in the room. We are pleased to have cspan here to film this evenings program. Pleased tonight it is an onstage conversation and there will be an opportunity for audience questions at the end. I will ask that you please wait for the microphone and speak into it clearly so the question can be heard. After the discussion the authors will sign copies of their book, the books are available here and the authors will sign the book here to my rights, if you could please a formal line at the table in front of the stage. That would be great. St for those with a book in hand i ready you can jump right into line. Thank you so much for supporting the library and its program, whether its through your yearly gift or purchasing a book at tonights program, these things all have the help the library to bring these wonderful programs to you. Tonight, we have a pioneering oncologist doctor vincent davida junior who is going to share personal history of one of the greatest science stories of our time. The fight against cancer. The book, the death of cancer, after 50 years on the front lines of medicine of pioneering oncologist revealed why the war on cancer is winnable and how we can get there. It is cold written by journalis, elizabeth, and yes they are related. We are privileged to have the opportunity to have them both here to discuss the book. It has received wide praise for his inside craftsmanship, hope, and humanity. Tonight, elizabeth will interview her father about his work and explore his personal story. Doctor debate arrived at the National Cancer institute in 1963, eventually becoming its director and moving onto top level positions at Yale University where he is currently a professor of medicine and professor epidemiology. Elizabeth davida rayburn received a masters degree in Public Health from columbia university, she she writes about science, health, and society. Her stories have appeared in the washington post, self help psychology today and Harpers Bazaar among other publications. Please welcome doctor davida and elizabeth davida rayburn [applause]. Thank you all for coming, can you hear me . Im a bit of bit of a low talker, i have two microphones on. So i have been asked to interview my father for you which is something i have done a lot of over the course of putting this book together. Though most of our conversations actually took place over text or maybe a scotch when were together. Well do are best in this format. And try to evoke some of the stories that came out. Before we begin, i like to introduce my mother, mary kk who lived through many of these conversations [applause]. B so now we will begin. So this book is about the war on cancer and your journey through. But most people do not really know that much about how it came to be. What you tell us about the back story. Ok is about th the one cancer begin 1971. S . Congress passed the National Cancer on the 23rd of december, 1971, as a Christmas Gift to the nation. It was a brainchild of mary lester, very wealthy philanthropist who lived in of greenwich, nearby among other places. Is a very Controversial Program for a lot of reasons. One of which is it proposed that the National Cancer institute be taken out of the National Institute of health and given a separate agency to the i president , it propose the fda it was controversial for another reason and that is to get it through congress she had great influence in the congress a promise of it past the cancer act it could eradicate cancer by the centennial. Now. Scientist and i believe that was true. No no scientist believed it was true. That afterward. [inaudible] it put 100,000,000,000 dollars billion dollars of tax dollars into Cancer Research. So this book is about my track through the war on cancer. So weve had Something Likee this in mind for a while but she was biding her time, while she waited for . Her husband died of cancer. I wrote a chapter called marion the machine. She had a machine, she was someone who in congress, she had ann landers wrote an open letter to congress that says you know you all to the American People so she had this big machine that she set into motion. It was very successful. Think a lot of people would be just surprised to discover there is one patient that had a lot to do with marys feeling that it was start to time to start pushing forward. Its ironic, it was 1969 and i was sitting in my office and the phone rang and it was a chemo therapist as we called it in those age and she said i have a patient was a gallbladder cancer, he had just beenensaid v operated on it was the most famous surgeon in the country, he lived in washington and he worked with congress and wanted to be treated and what i take him. And we were taking only the cases we worked on so i said i really dont work with the public. Also theres really nothing we can do at that time. There is one drug, right . Yes one drug. So i said thank i said thank you very much but i cant take him. Ten minutes later the phone rang and it was sydney farber, and he said to me and told me about the patient and he said i would like you to take inches and. And i said well doctor farber, e dont work with this kind of patient and he said you will take this patient. I was cocky but not stupid. So we took the patient. When i examined him, looking for lived nodes and felt him under both armpits. Well it doesnt go to lymph nodes under your arm. So irm thought something was wrong. We rebuy opposite and it turned out he had a lymphoma. And a and ame type that we were working on and now had a second treatment thatv we develop for lymphomas that was working well. We treated and he went into remission and mary lester use that as her cue. She said we thought we provided the missing link. Most people do not die from cancer where it starts, they die from a secondary deposits elsewhere. For example women with Breast Cancer dont die for cancer in the press, they die from metastases. We are. We are looking for ways to get drugs outside, once we proved we could treat effectively, no adults with cancer and we should. And we should say how lucas connected with mary. Ld talk abou luke quinn was working for the American Cancer Society. Mary lasker had planted him and paid his salary. He was her eyes and ears on the hill. He had been a colonel in the air force and he was the Armed Forces Liaison with congress so he had a lot of contact in congress. So he basically was part of here machine. The eyes and ears on the hill. He would identify congressmen who would support whatever effort she was putting in. Those that were neutral and mary would deal with each of them in a different way. He was a very important man. Once he was in remission he began to put witnesses together to testify before congress. He actually actually wrote the National Cancer act himself. He said, and i followed it as it went through congress, he never asked me to testify. And he never asked most of the people i suggested to testify. He he needed somebody who was more a believer, it was very interesting character. I do not think. I dont think any d conversation about mary is complete unless you talk about where she appeared and how she acted. There is nobody like mary before and there is nobody like mary rusk or sense. When i i first met her she was coming to the National Cancer advisoryry council. She would come and drape it over the back of the chair, she had u bouffant hairdo and every ten minutes sitting at the board room she would take out a compact and put her makeup on. You would get the impression that maybe she was just a frivolous observant. Nothing to be further from the truth. She was very sharp woman and knew what was going on. Then i met her when i became the director of the treatmenti division and one of the first phone calls i got was from mary and she wanted to ask come see me. I remember posting to my staff,n dont worry i can take care ofo, mary she came in my office in 15 minutes later she had me eating out of her hand. She was a very smart smart woman and a very m logical woman. You cannot really argue with some of her logic. So i became a believer and friend. Shes to take me around to congress with her so i got got to hear about her machine from mary and my experience comes from her. Sometimes she has unorthodox methods to advance her goal. Tell everybody about the lunch, is, is one of my favorite stories. Will now she had her machine in place. Ll in the spring you had budget hearings and so she would come down and she would stay with her budg good friend at a lovely home outside of washington. Blair then she would visit various congressmen and take me sometimes down with her to see the congressman. She would have dinner and lunches at the house. The dinners were always sitting next to somebody who needed the information you have. It was a very carefully planned. One day i got a call, to give you an idea of how much detail she went into. She said i got a call and she said will you come from lunch today and i said no i cant, i have clinic this afternoon. And her very stern voice said mary wants you to come, please come. So i rearrange my schedule, hopped in my car, drove it down a little late and theres a big black government limousine sitting in front of the house. I come in and and introduced to mr. Featherstone read. We had lunch in the regular and she wanted me to talk about what was going on. About an hour later he said he had to return to congress and left. Mary took her coffee to the living room and i went in with her and i said mary, who is featherstone read . In he said he is maggies driver. That was the chairman of the Senate Appropriations committee, the guy who handled all the money. Appropriatio so she saw my shocked look and she puts her hand up and said bins, he drives maggie to work every day, he drives mrs. Maggie around shopping all day and mrss person. She was surrounding him with people who are all primed with all the information she needed to pass the budget. I went back to my office and thought he did not stand a chance. So the warren cancer was a very popular id among politicians and the public when it was first passed but there are many doctors and scientists were appalled by it. It was a very Unpopular Program for small the implication was money was going to buy ideas. A. And people in academic save money doesnt buy ideas. Of course course that is not true. Money does buy ideas. You give money to good scientist they go to work and ideas pop out. T. But first value cannot pour money into it and make it work. That the universities want money to go into grants. The small grant Small Grant Program they used to support the faculty because thats how they support the faculty. So they were unhappy about the money being sifted out and they did not want anybody tellingpy them what to do. I remembered doctor rick ellison smiling and as a director of the Cancer Center you can agree with me on this one, is not terrible Popular Program in fact until very recently, it has not been a very Popular Program, i would i would say in the last ten yearsp tops. So you edit a textbook on cancer and i was actually gonna try to bring this home because it was 11 and half pounds but i cannot get it in my backpack. And you wrote this slim volume by comparison for the layperson, so what compelled you to go from writing for doctors to writing from laypeople . Ed you to go f well they said it was very clever to have this Treatment Program so i would have someone to chronicle what we did. To having elizabeth to work with was amazing so having the book readable is how she made it but theres another reason. First of all i think 100 billion is a lot of money. People who put it up know something about it. And they should know something about it the way it actually happen, nott an imaginary flowery language. Second, theres nobody, is very fortunate, is there at the Cancer Institute before the act was signed. The the work that we did in part led to it, became director of the Cancer Institute so i ran it. I went out to the biggest Cancer Center in the country as a physician in chief and then i went to an elite university and was president of the American Cancer Society and then i got cancer myself. So i could describe the whole thing. Given. Given the fact that i think the public needed to know and i had a unique opportunity, in fact we had been talking about it for 20 years. Knowing that at some point in time we should really do the book. If you have enjoyed reading it,i thats the reason right there. There are some things in the book that some might construe as being inflammatory, in fact you have gotten emails from people saying how courageous it is for you to have said the things that you said. Did anyone caution you about writing the things that you did or tell you not to doand it . E i guess five or six years ago i went down to mount sinais first sabbatical and my good friend jim holland, one of the pioneers in the chemotherapy field was there so we went out and had lunch, little Italian Restaurant down the street. And you cant describe him hes a boisterous guy who wears a loud ties. I told him about the book and he got very serious. And i was surprised. He looked at me very serious and said vince, people dont really need to know the stories, you really should not do it. And i said, i was a little shocked i didnt say would not do it but in the front of the book i mention the story and i have not yet heard from jim. Hes a wonderful man and one of the pioneers in the field, but it it was so out of character ot for him. Were you concerned about any responses you make it when this came out . We do tell stories about people and people seem surprised when i mention names and institutions until the truth. I think everything in the book is truthful as i can remember it. As elizabeth said to me, as people complain, tell, tell them to write their own book. And i would say go talk to elizabeth. What criticism do because of the hardest and how would you respond to it . Respo we were reviewed twice in new york times. One was was wonderful, the other was not bad, he said he liked the book. In the second to lastwas wonr paragraph. You said he would like to see on i was not writing a book about the whole feel, is writing writing about my experience. Then he said, and i describe a friend of mine that we took cars of, patient name lee and how i moved him from institution to institution to get access to drugs to keep them alive. He says at the very last, i i forgot to mention that the next new drug only proved medium survival by 2. 9 months. That annoyed me because one of my favorite depictions of this is what i call median disease. I was trying to get him into adm study where the survival curve was like this. Median being half the people at this point would survive. If you look at the survival rate 25 of the people were responding. So he was worried about median disease and is a statisticaln tool so we can compare studies. S and then a laboratory science, a dr. In london wrote a review and said its great but we do not know enough to do all of these things. My responses, you do not know enough but we know enough. The enough. The reason is Laboratory Scientist tendd to have people who spend all of their time in a laboratory tend to want to know everything before you do anything. In the cancer field you do not have to do that. What you have to do is fix critical parts of the cancer cell. During the time it is exposed to the treatment. In the book book we describe a hallmarks of cancer. A few can gene a them so you can get them back to where they were before during a period of time there exposed to treatment, otherwise we would not be able to do it we did with some of the other treatments. So those are the two that i think bother me the most. An and understandable, and we got very good reviews. I cant complain. Early in the book and chapter two you start with a scene from a party. You are at the nih and it is a party thrown by your bosses, one me to at the door with the overfilling martinis and eventually he slips on a table and crushes to the ground and passes out a bathtub. The other boss is seen carrying a lab tech over the shoulder at one point in walking on his hands. These guys are actually your mentors. You came to really admire them. So some people have asked why would you show them that way so early in the book. What were you trying to say there . Well mary kay remembers that night. We went to this party with all of these where the most junior people there. It was a little uncomfortable for us. By the way, tom fry who worked on his hands could walk on his hands better than most people could walk on their feet. He was really an athletic guy. Two reasons. Most people one is they are very important people. Throughout the book i make it clear their contribution was really very important. I thought it was important to describe them the way they were. They worked very hard and they played very hard. And then we have a photo and iyv can show it you look in his eyes and you knew he was a very intense person. I thought that was important. The other the other thing is i had to make a decision, these people were so far out of the norm of the field that when you go to the Cancer Institute you stay away from him but you would go there instead of vietnam to be shot at. We wanted to be there and people w said look its good to go for that reason but to not get too close to them. That was professional. Now im at a party and they sound like they areno just as crazy as everybody said there were. Running around getting drunk, walking on their hands. So hot i had to make a decision about am i going to stay with these people and work on this . The power of what i saw going what i saw going on there was so important that i realized it was the right thing to do. What what they were doing was really terrific. I was a little worried and i sent a copy of the book and wrote a note and said maybe some of the stories and make him uncomfortable if you remember them. Remember and i got a lovely letter for a month ago saying he loved the book. He thought it was important contribution and he was so proud that we worked together. Was so im very, very fond of the man. Hes still working, he is indestructible. May be a little mellower. A lot mellower than he was. We interviewed him for i think four hours for the book. That interview itself is it really very interesting, in fact Malcolm Gladwell wrote a book in one chapter in that book is all about j, he came and talked to me and i told him all the stories but i do not put all of them in. You first stepped out in 1963, can you just drive this word and what the patients were like when he first saw them. In 1963, if you got cancer, if you are lucky you are operated on and if you got it it was early enough that you might survive. But a lot of people didnt. Nd then radiotherapy was around but now another really good radiotherapy machines were. So the overall survival rate was around 37 for all cancers combined. Machines we chemotherapy was considered aco. Lunatic fringe. Most people do not believe in it. So the words were very peculiar. On 1i worked on both because i was in a laboratory that supplied young faculty to both. One was awarded with advanced cancer, all of whom died. Di and one was with just one drug. And another another ward was with children with leukemia. Upstairs was a lot of hostility toward doing this kind of thing. Young doctors coming in and never done it before, really unhappy. You may not have liked it and some people didnt, but there was no escaping it. He was a super dr. He hovered over his patients and he saw things happening that you never saw before. So despite the fact that weve been told to avoid these people. My eyes were telling me Something Different. I remember and we tell the story in the book, it was a great, very wellknown hematologist, at the Cancer Institute and he was in his two nationally known and we did bone marrow says we did all the time on these kids we got to take the slides down and george would read them and i would hand him the slides and he would say he had one eye under the microscope and look at me with the other and say this is crazy what theyre doing there. Just insane. And then he would say, okay yeah the marrow is coming back in the drugs are still in the veins of these kids. In the bone marrow is coming back in the chemo cells are disappearing. He says says hes crazy buddies tell me its working. Its just how lockedin the people in this or approach are. It was an an interesting time. We used to have rounds of almost ground rounds, and rick was on the 12th floor. We crossed paths and people would come up and shout things like this is a butcher shop. Li i never had this before. It really just seem to make some people that blood boil. We tried in people who are around at that time was that we capture the atmosphere of that time very well. We should point out what they the atmo were doing on the words that were so different. At that time, using drugs in combination was considered bad medicine. It started out bad medicine and Infectious Diseases you didnt give to drugs at a time. Cancer drugs were considered to be worthless. So giving to toxic drugs at the same time was considered bad medicine, giving four was considered a little insane. And they had developed a program and each initial stands for a different drug in thethey develd combination. It turned out to be a very useful combination. Upstairs there giving drugs one at a time. They were unhappy with any thought of doing anything because we did the mock program upstairs. It was a very interesting time. The turmoil was unusual to say the least. So mop was a regiment you came up with for hodgkins disease but that was not your first stab at it. Tried it theres so much bad feeling about doing it. We we had to do a pilot trial and we called it mumps mom p, again an initials for the drugs. It was a short study, it was a little more toxic but what happened was we put patients in program. Reverse isolation and were very careful because wherever they would get infected. We did have drugs to control nausea and vomiting. So these people got sick is a very trying time the first 14 patients went into remission. Ni so we began to face a veryso we unusual problem we knew we need to to do something for longer duration. When you treat leukemia you are treating the bone marrow. Thats where thats where the key missiles come from. You continuously treat until the leukemia cells are gone and thes co you stop. Whether you are treating Something Like hodgkins disease there marrow is normal so you. Have to work around the marrow and you have to give it longs enough so you do not let the tumor regrow between treatment. So we did mouse experiments and then we made translations from the mouse to the human and studied the bone marrow in human and mouse. We came up with a fairly complicated schedule, i did this with my first partner in this and jacket did them mom pub and i did the mop. M hes an interesting fellow and jack said he wanted to be a dean when he left there. Nobody wanted to be a dean. So it was very unusual. Sure enough after we did the program jack went back to boston and three yearsrs later he was the youngest deanan of the medical school in the country. People asked country. People asked me what happened to jack, he just disappeared, but he is still around and we still stay in touch. So tre we converted mom put intp with a very complex schedule. What was the biggest obstacle to getting mop out to patients . Obst so after the first years were pretty sure that if the patient was going to recur it would recur within the first four years. We are pretty confident we cured them. The data was very good. T but youre asking people who had never done things like this tos use the combination. If you did not believe it could cure then youre making patient sick. So getting doctors to work on the schedule that you put together was very difficult. Hi i tell the story. I went out for grand rounds and they warned me when i was coming up that they cannot make it work and theyre going to grill me pretty good. My father who lived in new york decided he was going to come and he sat and then they got up and said we cant make it work. Te then the implication was the kindest implication was that i was taken easy cases and they were taken the hard cases but the reverse was true. Or somehow that i was fudging the data. So i finally said to them, what, what you do. How do you give it . And he said we do not like nitrogen mustard, so we use ourr own drug. And we put a dose that is easy to use. Drug and they. To use, another drug makes you drop so we cut that drug in half. Another causes nerve damage so we cut that. Then the we worked out a schedule so we could get the drug in and keep the tumor from grayback without damaging the marrow. And putting two weeks between the cycle. So i finally and so it blew up in said how do you do this . And i said outpatients come to us on the subway and we dont want them to vomit when they are going home. So i said to them listen, could you tell the patient that they can vomit and be cured or not vomit and die of the disease that maybe they a tackle developed hodgkins with 6foot 7 inches and 260 pounds when they calculated his dosageaccorg they said this is crazy and they will not do it so i had to inject this giant with schaede dose of the giant surface body area. A so i had to go into the clinic there were all expecting him to fall over dead but the ticket and went into remission but that isre the problem because in private practice you need regimens that you can give them easily. And dad biological target. Vivald if it is a said it should be approved. We oh they were done in the post marketing period. To let them come up with the new ways. In the way to do that is based on safety. So it is the phase one andnd phase two studies. Into retirement retain their right to to cut again and audit. In some cases it takes 800 thro. And then it goes through some more. Again. We havent mentioned that yet but one of the beatings that i had attended as a society of jabbering idiots. People take the piece of chalk. But if you check the latest information and you decide how you adjust the protocol. Ay e so if you do what i said on the basis of safety you could revolutionize. This is actually less expensive. But the fda would not do that on their own. Not give so to take some interesto from the congress. We need another eight and landers. [laughter] had never read to a meeting that they didnt refer to her as the angel of mercy. Mercy. But we dont have any organization. G what changes are in motion . A lot of people ask me questions about the papers recently that are very exciting. E and then we were looking but we didnt know why. And then discovered in the checkpoints. In the way that we have bodies that attackers attacker cells. Heckpoint the with the checkpoint and then to be approved for use with melanoma. Now theyre living years. Cancera touche just lung cancer that is very difficult to treat. Pretty much every center it is tried not to the same degree press cancer is there but we worked out the details. De now we have immunotherapies and chemotherapy and we can mix and match and now we kidded, jr. The tcells you can find the mutation into sequence the genome to find the mutation and. That was uniq ever seen. O those responses that is very personalized madison. Genome, find a so you have to put a very sophisticated laboratories but as time goes on it will be more widely available. Re we n but the mandate was to support research about 70 percent of 100 billion. Barry said i would ask to madrid million above the budget nothing that i can sa kid justify and she said dont worry i will only get 5 mi. 95 million into laboratory research. So we supported the research because the Smoking Cessation programs have been very successful because we can prevent the polyps from going into malignancy. To to be older in the field hasld its advantage with a difference of the outcome and it takes five years to thats myhe data. And that is my estimate. Pportede and to reduce mortality. And that was not possible but the best is yet to come. The and those who are dead even measuring that impact are those targeted their peace. What you think is the role of hope for treatment of cancer . If cells have energy pumping ions when you die there is no difference. Theres c and those who were even responding to treatment gave up and died. So you have to say i will do ino this is an important component for pope patient with hodgkins is alive today he said to me when i leave here i get the treatment then you what the side there were two pools of they are symbolic i would take off my a sox issues and it worked and that is the treatment i said i will take all the help i can get. [laughter] my husband had Esophageal Cancer from Harvard Medical School but that is a very difficult cancer than the problem with swallowing after any progress . Sually dont we usually dont do surgery alone in a more. T of peo unfortunately it is still difficult to treat. Rapy and che. And that is to advance. It doesnt make any itserence. It is easier to give radio their peak in chemotherapy did the surgery. Easier to give that is one of the tough ones. Talking about the cost of cancer care even if the approval process was shortened all lots dont have those means. And pat what about the pharmaceutical side . Received ran he was receiving radiation into his brain