00;00;00;17 - 00;00;06;19 Dr. Winn I'm Dr. Rob Winn and you're listening to Real Cancer Talk from VCU Massey Comprehensive Cancer Center. 00;00;07;14 - 00;00;36;12 Dr. Winn Well, we want to welcome everyone, today to this Facts Faith and Friday. As you know that, this is one of my favorite times of joining, with you all. In the context of giving our information that we think is, not only valuable, not only, interesting, but also useful. This is another Facts and Faith Friday where I think we're going to have, an amazing lineup today. 00;00;36;15 - 00;00;51;03 Dr. Winn Someone that I am just, again, I not only respect, but I like a lot in the. When they say the apple doesn't fall far from the truth. The proof is in the pudding. She has, as a first cancer center director 00;00;51;05 - 00;00;56;29 Dr. Winn for the NCI, woman cancer center director. But beyond that, she's just fantastic. But you'll hear more about that later. 00;00;56;29 - 00;01;11;10 Rudene Mercer Haynes Thank you, doctor Winn. For those of you who don't know me, I'm Rudy Mercer Haynes. I'm happy to be with you this beautiful Friday. We have got lots of great news. We have with us doctor Monica Bertagnolli, who is a trailblazer in many respects. 00;01;11;10 - 00;01;19;28 Rudene Mercer Haynes And I know you told Doctor Winn that he could call you Monica. I'm not going to do that. But I call you doctor Bertagnolli. 00;01;20;00 - 00;01;44;28 Rudene Mercer Haynes But I'm going to read your bio because it's it's incredible in every way. And hopefully I'll do it justice. But you're the 17th director of the National Institutes of Health. You were nominated by President Joe Biden on May 15th, excuse me, 2023. You're confirmed. Hallelujah! By the US Senate on November 7th, 2023. And you took office on November 9th, 2023. 00;01;44;28 - 00;02;12;16 Rudene Mercer Haynes All very important dates. But what makes Doctor Bertagnolli so special? She is the first surgeon and the second woman to hold this position. As the NIH director, Doctor...Yes. Celebration. That's amazing. Dr. Bertagnolli oversees the work of the largest funder of biomedical and behavioral research in the world. She previously served as the 16th director of the National Cancer Institute. 00;02;12;22 - 00;02;47;27 Rudene Mercer Haynes Again, rock star, the Richard E Wilson Professor of surgery and surgical oncology at Harvard Medical School, a surgeon at Brigham and Women's Hospital, and a member of the Gastrointestinal Cancer Treatment and Sarcoma Centers at Dana-Farber Cancer Institute. Throughout her career, Doctor Bertagnolli has been at the forefront of the field of clinical oncology. Her laboratory focused on advancing our understanding of the genetic drivers of gastrointestinal cancer development and the role of inflammation as a promoter of cancer growth. 00;02;47;29 - 00;03;23;27 Rudene Mercer Haynes As a physician scientist, she led translational science initiatives from 1994 to 2011 within the NCI funded Cooperative Groups program, now known as NCI National Clinical Trials Network, and from 2011 to 2022, she served as Group chair of the Alliance for Clinical Trials and Oncology, a National Clinical Trials Network member organization. In addition. When do you sleep? In addition, from 2007 to 2018, she served as the chief of the Division of Surgical Oncology for the Dana-Farber Brigham Cancer Center. 00;03;23;29 - 00;03;51;27 Rudene Mercer Haynes Doctor Bertagnolli has championed collaborative initiatives to transform the data infrastructure for clinical research, and as founding chair of the Minimal Common Oncology Data Elements, MCODE, Executive Committee. She also is a past president, chair of the Board of Directors of the American Society of Clinical Oncology, and has served on the Board of Directors of the American Cancer Society and the Prevent Cancer Foundation in 2021. 00;03;51;27 - 00;04;19;03 Rudene Mercer Haynes Again, you have many accolades, but this is pretty, pretty impressive. She was elected to the National Academy of Medicine, having previously served on the National Academies National Cancer Policy Forum. The daughter of first generation Italian and French vast immigrants, Doctor Bertagnolli grew up on a ranch in southwestern Wyoming. I have so many questions, but I'll reserve those for later. 00;04;19;06 - 00;04;45;00 Rudene Mercer Haynes Amazing. Amazing. She graduated from Princeton University with a Bachelor of Science and Engineering degree and attended medical school at the University of Utah. She trained in surgery at Brigham and Women's Hospital and was a research fellow in tumor immunology at the Dana-Farber Cancer Institute. I am a lawyer by training, but sometimes all these medical words get me kind of, you know, little discombobulated. 00;04;45;00 - 00;05;06;04 Rudene Mercer Haynes But anyway, Doctor Bertagnolli again, it's a real blessing for us to be able to sort of share the same space with you today. I have admired you from afar. And I appreciate your your own, your journey. But with that, I'm going to be quiet, and I'm going to turn my camera off and I'm going to yield the floor to you. 00;05;06;06 - 00;05;26;09 Dr. Bertagnolli Well, thank you so much for that. Just so gracious and generous introduction, and all of you, for allowing me to be here with you today. I've been so I was telling Doctor Winn, I've been looking forward to this for a long time, and I'm just so glad we finally, it finally became possible where we got to spend some time together today. 00;05;26;12 - 00;05;46;09 Dr. Bertagnolli Maybe we can put up the slides. Start with those. So I was going to introduce myself, but, you know, there's been such, such a thorough job done. I'm going to skim through those really quickly and just tell you a few things. I think that kind of do define how I feel about, about my profession and my life. 00;05;46;11 - 00;06;06;04 Dr. Bertagnolli And then talk a little bit about my vision for NIH. And then a specific, update on what's going on with what NIH is trying to do to conquer long Covid. Next slide. So, I am a surgeon. First time I walked into an operating room based, by the way, I wanted to be an immunologist. 00;06;06;04 - 00;06;31;27 Dr. Bertagnolli I wanted to be, you know, a medical doctor, take care of patients, in, in the clinic, do immunology. And then I walked into an operating room and. Oh, my goodness, that was just, where I belonged. I felt that way. So I was so privileged to be able to pursue a career in surgery. This is me, just this year, no longer the big surgeon in charge. 00;06;32;00 - 00;06;52;12 Dr. Bertagnolli But this lovely woman right beside me there. I'm on the right, far right. The woman right next to me there is Doctor Stephanie Goff, who was one of my fellows in the research laboratory and a trainee in surgical oncology, and is now one of the senior surgeons at the NIH Clinical Center. And it's a beautiful thing because I get to be her first assistant. 00;06;52;12 - 00;07;15;27 Dr. Bertagnolli And that is an amazing honor. And I'm not going to go through this, all of this stuff. But what I am going to say is, you see down there on the left, that beautiful mountain back there, those beautiful animals, that country. And I was so fortunate I got to grow up in the West in this beautiful land, with wonderful family, wonderful community. 00;07;15;29 - 00;07;36;19 Dr. Bertagnolli But something very important about it. It’s 100 miles to the doctor's office. It's 100 miles to a hospital. And so I grew up in an environment like that. My inspiration to be a doctor came from my uncle, who was a primary care doctor who took care of the veterans in Wyoming, all of the veterans in Wyoming. And Wyoming is a big place. 00;07;36;19 - 00;08;08;00 Dr. Bertagnolli He would travel across the entire state and take care of the vets. They were his responsibility. And that was he was just I just adored him as my uncle and inspiration, and he taught me so much about what it is to care for people everywhere. Eventually I had wonderful colleagues in the academic world, got to meet so many people through the work that I did, and eventually came to NCI as the director. 00;08;08;02 - 00;08;40;16 Dr. Bertagnolli And it was pretty soon. Another thing I love to share with you, pretty soon, six weeks after I became NCI director, I got my own cancer diagnosis. I went in for a screening mammography, and there it was, had a biopsy immediately. And, I was on a cancer somebody with cancers journey. So, those of you out there who've had this disease, I feel, solidarity with you. 00;08;40;18 - 00;09;06;02 Dr. Bertagnolli And I will tell you, I am so grateful. I'm fine. I've gone through my chemotherapy, surgery and radiation all three. And I'm incredibly well and feel well. And my prognosis is wonderful. What it will. Let me tell you. Why am I doing so well? It's because of the work that was done by the National Cancer Institute over many, many decades. 00;09;06;08 - 00;09;31;03 Dr. Bertagnolli And even more important than that, it's because I added them up. It's because of more than 140,000 women who agreed to be in cancer clinical trials for breast cancer, for the kind of breast cancer I had. And everyone asked me, well, you know, what's the thing that's really been different about a surgeon and a cancer specialist having cancer? 00;09;31;10 - 00;10;00;17 Dr. Bertagnolli What's the thing that you didn't expect? I just can't tell you how actually living this myself has made me so profoundly grateful to those women who had the courage and generosity to deliver for me the treatments that have been so successful, so incredibly grateful. Okay, now let's shift to my new job. I am very worried that the health of the US population isn't getting better. 00;10;00;17 - 00;10;02;00 Dr. Bertagnolli It's actually declining. 00;10;02;00 - 00;10;15;25 Dr. Bertagnolli We do have a lot of miracle things that are happening in medicine. But they don't get to everybody. And that is a terrible tragedy and something we absolutely have to counteract as soon as we possibly can. 00;10;15;28 - 00;10;35;29 Dr. Bertagnolli This is just the facts. Looking at one crude way of showing that our our we're not doing so well. Our life expectancy was going up, up all the time. And now for a while it's been declining. And it really took a hit with Covid. I guess that's expected. Terrible, terrible disease. But we haven't come back to where we should be. 00;10;36;01 - 00;11;06;20 Dr. Bertagnolli And we're we spend more in America on health care than any other nation in the world. But you can see here our life expectancy compared to other nations is far lower. Look who is high on this list Japan, Switzerland, Korea, Australia, Spain, France, Canada, China are all ahead of us. And in fact, our life expectancy is equal to the nation of Vietnam. 00;11;06;22 - 00;11;42;05 Dr. Bertagnolli Which hasn't had the biomedical intervention innovation that the US has. So there's something very wrong here that we need to pay attention to. Next slide. And of course, we pay so much more for our health care. So we're not getting a good return on our investment here. You can see here that it's not even close, comparison of how much everything is paid out if you averaged it out per capita on the US population, compared to our other nations that are doing so much better in safeguarding the health of their people. 00;11;42;06 - 00;12;19;10 Dr. Bertagnolli Next slide. So how can we what are we going to do about this? What can a research institution do about this? Next slide. Well here's first and foremost on the list. If you look at a map of our nation and you look at healthy life outcomes, economic advantage, if you look at all the, the favorable factors and then you look at where there's favorable social determinants of health, and you look at where we have poor health and their inverse maps. 00;12;19;10 - 00;12;57;27 Dr. Bertagnolli Right. It's very it's crystal clear that our map shows us, where people are being left out. People are being or having inferior health. But the same thing with that map is it's also the same people that we don't have participating in research. Now, there's two reasons for that. What we do know from much work that's been done in the cancer community is that if a person is participating in research in medical research, they generally get better outcomes, even if they're getting the standard treatment. 00;12;58;00 - 00;13;31;28 Dr. Bertagnolli Why? This is because teams that can conduct research generally have more resources, more ability, more interactions with colleagues across the whole United States and the world and can offer new cutting edge treatments to patients, but also offer even the routine care. Routine is never that's nothing in medicine is ever routine. But even the care that's not experimental, that's not investigated, gets offered in a more robust way. 00;13;32;02 - 00;13;55;05 Dr. Bertagnolli So number one, research participation does really help drive better health. And we get too many people who are being left out of research participation. Then the second thing is people are all different. Okay. We looked at the map. We can see if you live in a different place, if you belong to a different community, you're going to have different health. 00;13;55;07 - 00;14;27;08 Dr. Bertagnolli You're going to actually need a different way of solving your health problems. Health is deep as a community, event and as affected by the community. And if we don't aren't in these communities, then we're not going to be making progress for them. And then you can see here kind of the usual communities we think about. But as you I think you can also hear by what I'm saying, I take a very broad view of this, but traditionally we don't have a lot of data 00;14;27;08 - 00;14;51;00 Dr. Bertagnolli we need to do better for people who are older, uninsured, belong to some major minority groups, live in rural locations where it's 100 miles to the doctor's office, have many other comorbid conditions. When people are sick and they got a lot of things going on sometimes, sometimes they're left out of research because we don't want to want to add too many things to the study. 00;14;51;00 - 00;15;13;18 Dr. Bertagnolli We're doing. Well, we've got to stop that because these are people we need to take care of, so we need more knowledge about them. And also little tricky thing, people who are who are not part of institutions, organizations, doctors groups who are used to doing research tend to receive more nonstandard treatment for all kinds of funny reasons. Next slide. 00;15;13;21 - 00;15;30;18 Dr. Bertagnolli And we know the barriers, you know could be you can't get to the doctor. It could be you don't have the the funds that it takes to because healthcare can be expensive even if you have insurance it can be you're working two jobs trying to get going. Who's going to go to the doctor for your health care there? 00;15;30;20 - 00;15;58;18 Dr. Bertagnolli It could be that, nobody, you don't have anybody to watch the kids, you know, think about it. What if a woman like me doesn't go get her mammogram that can save her life because there's nobody to watch the kids? All these things are barriers. They're not only barriers to care. They're barriers to research. Next slide. So here is a very important principle for us at NIH. 00;15;58;20 - 00;16;25;08 Dr. Bertagnolli Our research encompasses the laboratory the clinic. And it does not stop at the door to the doctor's office because it has to go deep into the community and we all know we're all human beings, but all of our communities are beautifully different, in wonderful ways, but also in ways that impact what our health can be. Next slide. 00;16;25;11 - 00;16;46;03 Dr. Bertagnolli All right. I'm so excited about this. This is the initiative brand new thing we've got at NIH that's near and dear to my heart. It's a new program called Communities Advancing Research Equity for Health care for health. For sure. What does this do? You can all read the words on this slide, but let me tell you why we did this. 00;16;46;03 - 00;17;16;08 Dr. Bertagnolli First, we know we have to be humble. We don't understand the best ways to bring health to many communities, because we're not part of those communities. We have to get into these communities where research has not been done before again, because those are the communities who have the worst health, and we can't assume we go in there and know, number one, what people really need. 00;17;16;10 - 00;17;48;18 Dr. Bertagnolli Number two, how people really want to work with us. And so we have to learn from them. So the principle of care for health is step one. We get researchers who go to and into and ideally are part of a community. We first ask the community and many different ways to do this. What do you need? What are you, what is, you tell us. 00;17;48;18 - 00;18;08;20 Dr. Bertagnolli What's your biggest problem? I can look at the map like anybody else. I know where, you know, all the different maladies we worry about are the highest. But I want to know what your community considers your biggest problem. Because that's going to be top of the list. Okay. For what? We are going to try to work with you to study. 00;18;08;23 - 00;18;30;15 Dr. Bertagnolli And it could be and this is the beauty of being that entire NIH, not just the National Cancer Institute, but all of NIH, because when we go into the communities, we're going to say, well, okay, what is the problem? Is it is it high blood pressure? Is it obesity? Is it maternal health? Is it mental health? Is it substance abuse? 00;18;30;16 - 00;18;54;22 Dr. Bertagnolli Is it cancer and cancer screening? Any of those things. NIH can bring a research program that can engage people in that. So I'm pretty sure that there's not much that people can tell us. This is our biggest concern, that we're not going to be able to bring a program in to bring that to bear. I'll tell you the reason why. 00;18;54;25 - 00;19;36;03 Dr. Bertagnolli There's two reasons why we've we've developed the program this way. First of all, we have to be humble. We don't know what's going to work best for a community. And number two, we don't expect or demand people's trust. We have to earn it. You know, it's an act of trust to participate in research. It's an act. And we know that and I think the, the way you earn trust is by being there, being present and showing that what you're there to do is to listen to what people need and then help them get it. 00;19;36;06 - 00;19;57;14 Dr. Bertagnolli So, that's that's the overall principle of care for health. So what are the nuts and bolts of how we're going to do this? What we're going to do is we're going to address these research issues important to diverse communities, particularly those underrepresented. We're going to. And we're not going to be helicopter in, helicopter out. We're going to be in there for the long haul. 00;19;57;14 - 00;20;23;03 Dr. Bertagnolli This is what it means by this middle. Achieve longitudinal direction of clinical data to assess people's health across the lifespan. We want the moms, the babies, the kids, the adolescents all the way up to grandma, great grandma and great grandpa and understand what we need to do, how the community, supports their health and how we can support that community to make it even better. 00;20;23;06 - 00;20;49;02 Dr. Bertagnolli And then the last thing I will say is, this is based off of primary care providers. Why? The place where I grew up, there weren't any oncology specialists. There weren't any cardiologists. We had our local primary care doc, like my uncle who went around the whole state taking care of people. Primary docs on the front lines of health, and they haven't been empowered to do research very much before. 00;20;49;09 - 00;21;12;09 Dr. Bertagnolli Why? They're too busy. They're on the front lines. There's, as you know, during Covid, we lost a bunch of them because they burnt out. And so part of this is we have to make it possible for primary care providers to be involved in research, to bring research to the people in their communities, and that's going to take a lot. 00;21;12;17 - 00;21;47;24 Dr. Bertagnolli It's going to take investment, it's going to take time. It's going to take long term sustainability to have that kind of a practice, active and viable for our communities. So that's the other, part of this. It's that addressing what the communities need and also empowering, supporting and really ensuring that the primary care provider, which helps keep everybody healthy, will be the one who will be our partner along with, the the community members. 00;21;47;27 - 00;22;17;29 Dr. Bertagnolli Okay. Next slide. So now, my next topic, boy, long Covid. So we got hit with a new and terrible disease in early 2020. And it wasn't too long after that that we started understanding that some people weren't getting better. Many people were dying, but even those who survived, many of them still had troubles. And some they're not such a big deal. 00;22;18;00 - 00;22;40;15 Dr. Bertagnolli My husband lost his smell, which he tells me, you know, living around my two teenage boys is probably a good thing. But no, he, you know, he lost his smell. Not a big deal in his life. But other people, some people, after their Covid, have such severe fatigue, they can't get out of bed. Some get this weird tachycardia syndrome where they can't. 00;22;40;16 - 00;23;06;21 Dr. Bertagnolli If they stand up, suddenly they pass right out. Some, have brain fog, you know, they just can't find their keys. Don't know where, you know, we just can't don't get through the day with the sharpness that they had. And these aren't aren't those of us who are getting older where that happens. These are young people. And there's a bunch of other symptoms, you know, chronic headache, joint pains. 00;23;06;23 - 00;23;33;23 Dr. Bertagnolli And we know this is caused by the Covid, the Covid virus. So we had to figure out how we were going to treat that because we did a very large study of 30,000 people across the entire United States. Doctor Gary Gibbons was the leader of this in the NHL by Institute, IT and NIH, along with the Neurologic Institute and the Infectious Disease Institute. 00;23;33;25 - 00;24;05;18 Dr. Bertagnolli They did a brilliant job with the grace of 30,000 people to actually figure out what long Covid was, what symptoms, how we could diagnose it based on symptoms, and then after that, they've launched a series, number one, clinical trials. But even more important, a lot we we we recognize we need a lot more understanding of the biology of what this darn virus is doing to people. 00;24;05;20 - 00;24;27;11 Dr. Bertagnolli Is it staying in the body and replicating? Even though, you know, has the body not been able to clear the virus out so that the active virus is still there? That's kind of our leading hypothesis right now, that why these people are not getting better, but we don't know for sure. Because we don't have a test, believe it or not. 00;24;27;13 - 00;24;56;04 Dr. Bertagnolli What is it, 2024? We still don't have the ability, when these sneaky viruses hide in our tissues to detect an active or growing virus. So right now we're based on symptoms to identify people, and we're based on a couple of clinical trials to actually treat the disease. One of them is keeping up with antiviral therapies to try to help the body clear the virus. 00;24;56;04 - 00;25;20;08 Dr. Bertagnolli There are other immunological, treatments to try to boost the immune system to get rid of the virus. And, and, but I think I've told you the last and the other thing I want to say before I move on, is, from this slide is that the sneaky virus can be anywhere. It can, it can see here I've lived we've listed all the organ systems. 00;25;20;10 - 00;25;53;07 Dr. Bertagnolli It really is something that has a terrible effect on, on some people's bodies, anywhere from 6 to 12, 10% of people. I want to tell you two things that we've learned for sure from the big data systems. Number one, the best way to prevent from getting long Covid is to have your coat. If you do get an infection with Covid to have it be as mild as possible. 00;25;53;09 - 00;26;19;13 Dr. Bertagnolli And the way to do that is to get a vaccine and to maintain your vaccine, because vaccine, you know, doesn't completely eliminate you ever getting Covid. But it sure helps in a very dramatic way, keep people out of the hospital from having a fatal, response to Covid and from getting long Covid and believe me, long-covid is something we'd much rather prevent than try to treat. 00;26;19;15 - 00;26;51;02 Dr. Bertagnolli That's number one. Another result that came out that is really important is that pregnant women who get Covid are more likely to go on and have long Covid. It's another solid fact we know now. And so any but any person who is pregnant, really also needs to take double protection to ensure that either you avoid Covid if at all possible, or by wearing a mask if you're going to be in a big crowd, especially when we see the waves like we just had. 00;26;51;05 - 00;27;23;12 Dr. Bertagnolli Or, definitely be vaccinated. Okay. Next slide. There's a lot things that this recovery program is done understanding the clinical diagnosis, defining the risk factors studying the pathogenesis that what that that's a long medical word that means what is this bug actually doing to the cells and tissues of your body. What's it doing to your immune system. We have to do all those things before we can really be smart to and identify ways to cure this. 00;27;23;14 - 00;27;49;13 Dr. Bertagnolli What are our guiding principles for all the research we do, but, you know, we're practicing them. Practice what we preach in long Covid patient centered. We don't call people who participate in research research subjects anymore. They're not our subjects. They are our partners. And that is absolutely critical. And if there are partners, they also help us design the studies so that the results are going to be more meaningful to them. 00;27;49;15 - 00;28;15;28 Dr. Bertagnolli It is national scale. It's very inclusive, diverse participation. I am so grateful for the communities that have joined us from all walks of life, to help us conquer this. And then we bring in our scientific vigor, standard methodology with scientific rigor, so that when we get an answer, we know it's the truth. We know we can count on it. 00;28;16;00 - 00;28;36;16 Dr. Bertagnolli Next our oh, and then last one, adaptive approaches is based on emerging science. We learn, we change, we grow, we get better, and we constantly have to adapt. And I think this is something that sometimes is hard for the public to, to, to, understand, you know. Well, wait a minute. You've been telling us forever, 00;28;36;16 - 00;28;55;00 Dr. Bertagnolli do it this way. Now you want us to change and do it a different way. You know, we need to. We need to be able to adapt when our science tells us there's a better way. Next slide. So next phase, and I think I'm almost ready to the end. Here is we've now going to launch. We've learned a lot in the last couple of years. 00;28;55;02 - 00;29;16;29 Dr. Bertagnolli We're now launching something called the RECOVER Treating Long Covid or TLC phase. We're going to launch a lot more trials based on what knowledge we've had. We're having a big meeting next week, starting next Monday at the NIH campus to, bring together all the experts in the world. We've got 1800 people signed up to be online, and we're going to have them participate. 00;29;17;01 - 00;29;43;12 Dr. Bertagnolli Health care providers, advocacy organizations, the federal government, everybody to weigh in on this. And, take a look at everything we've learned and now move forward with new knowledge to do research even better. And help plan the next round of long Covid trials so that we can conquer this. Next slide. One last principle, the most important one at NIH. 00;29;43;14 - 00;30;06;08 Dr. Bertagnolli Our work is never finished when we deliver scientific discoveries, although that's what we are here and have to do. Our work is only finished when our people, and I do mean all our living long and healthy lives. And this. This is the principle we live by. Next slide. So thank you again for letting me meet with you. This is wonderful and I look forward to your questions. 00;30;06;10 - 00;30;34;11 Dr. Winn That was outstanding. You know, it reminds me and, sister Rudene I was thinking about this, of a couple of talks we've had where you can literally look at the fact that there's this disconnect between people doing the science and how the science actually gets the people. And to hear from the top research program in the land that, that community is a focus, I think is really not only refreshing but energizing, particularly for our for our group. 00;30;34;11 - 00;30;42;01 Dr. Winn So thank you for that. I was going to turn the floor back over to, sister Rudene. 00;30;42;04 - 00;31;08;19 Rudene Mercer Haynes Again, I echo everything that Doctor Winn said. That was amazing. And thank you for telling us what's going on at NIH. Now, I have to tell you, my my phone start blowing up when you start talking about the care initiative. At NIH, we have a wonderful pastor out in the northern neck, pastor Tyrone Williams, who asked a question about how can a particular rural community actually participate in this study? 00;31;08;21 - 00;31;31;07 Rudene Mercer Haynes Again, I know you know everything about every little, you know, doc on the map in terms of cancer mortality and death rates and whatnot, that, you know, the Northern Neck is a agricultural area where cancer mortality is one of the highest in Virginia, and I daresay the nation. So, how can I meet communities or raise their hand to say, yes, I'd like to give. 00;31;31;09 - 00;31;50;28 Dr. Bertagnolli All I know. And and this it has been just so heartwarming to hear these responses. Right. So okay, here's what we're doing. First, you probably all know I don't know. I think it's public knowledge. The NIH, this is a new program never been done before. And and I kind of got a cut in our budget this year. 00;31;51;00 - 00;32;06;17 Dr. Bertagnolli So we didn't have a lot of extra money to be going out making brand new programs. How did we do this? We. But we couldn't wait. There's no way we were going to wait. So, a bunch of our institutes and centers, kind of everybody chipped in, this really is, you know, people say, oh, NIH is just some big silo. 00;32;06;17 - 00;32;34;18 Dr. Bertagnolli The cancer people don't never work with the lung people. And I'll own quite the contrary. So cancer centers, they pitched in. And what we've done is we have got the resources. It'll be they'll be announced next week publicly to fund three major hubs. And what those hubs look like is it's an it's an academic center. You know, maybe VCU one day it's an academic center with the research team there. 00;32;34;20 - 00;32;57;29 Dr. Bertagnolli But then that academic center shows us, which I know Doctor Winn is the master in this, how they are able to who their communities are, who the communities are, that are that are connected with them and, and then identify where the team needs to go. The team from the home home hub needs to go and bring those communities in. 00;32;57;29 - 00;33;22;16 Dr. Bertagnolli Now what do we bring? We bring the resources, the technologies, the help to give those primary care doctors the support they need, give them the tools they need and the funding and the time to be able to do the work. So it's coordinating through a major hub and then goes out as far as that hub can bring it to the community. 00;33;22;16 - 00;33;43;15 Dr. Bertagnolli And I kind of think it's going to be as far as our money is going to stretch to bring it to those communities. Right. We're going to start in a pilot phase because we've got a lot to learn first before we scale to the whole nation. So we're we have three major hubs starting this year. And I think you all know the federal government turns over its funding year on October 1st. 00;33;43;18 - 00;34;04;19 Dr. Bertagnolli So I got three that are coming in this year. And then very short after, there's going to be three more. And these are places that have applied to us and showed here's here's our communities. We want to be part of this. But it is absolutely my goal. And I'll tell you every time I go to meet with our Congress congresspeople, I tell them, hey, we need this for the whole nation. 00;34;04;19 - 00;34;23;07 Dr. Bertagnolli We can't leave anybody out. That whole map needs to be filled. So we're going to start over this year and next year with these six hubs. We'll learn a lot in the first year about how to how to do this. And by the way, the hubs are deliberately chosen to be in very different parts of the United States. 00;34;23;14 - 00;34;55;01 Dr. Bertagnolli But the common principle is they are all serve. It's totally focused on primary care and rural, mostly rural communities to start with. But very soon our inner city challenged communities as well. So stay tuned, because I know I'm determined that at some point, communities like yours will be will be involved in this, hopefully tied very closely to your wonderful local friends. 00;34;55;03 - 00;35;18;04 Dr. Winn You know, wonderful. And by the way, we have at Massey, we, have a tagline where we talk about one team, one fight and really that it really is to align our efforts around making sure that our communities are healthy. And so in that context, we also understand that we've had lots of meetings with us, and particularly this group, about raising the awareness in our voices about what the great work happens at the NIH. 00;35;18;06 - 00;35;47;05 Dr. Winn In that context. There's a question that I just had, though, about, given the fact that you're the head of the NIH, I'm think I'm getting this right, and that the fact that we know that obesity is an epidemic in the United States, how is the NIH addressing the research related to, the obesity epidemic that really is driving what we believe is a lot of, diseases from, you know, diabetes to cancer. 00;35;47;08 - 00;36;13;19 Dr. Bertagnolli So many different directions. Okay, let me start with the one. How did we get how do we get our obesity in the first place? I'm sure you all know about this whole thing. We're all really intensely studying in the field of ultra processed foods. You know, when our forefathers and foremothers were out there with their, you know, eating what they grew and, with their vegetable gardens, they didn't have this problem. 00;36;13;19 - 00;36;44;02 Dr. Bertagnolli They were healthy. They were living off the land, and they were healthy. But over the next 100 years, we got addicted to this. And I think addicted is the right word. You know, that our, neuroscientists have actually done the studies and for these ultra processed foods that, you know, are tested on us for us to just want them and we don't want to eat one, we want to eat the whole bag is it lights up all the same sensors in your brain as some of these other addictive substances. 00;36;44;02 - 00;37;03;24 Dr. Bertagnolli So so those kind of foods are not. So number one, the food we eat is really important. I know we've been saying this forever, but it's actually even more powerful to have this new brain imaging to show that's exactly what that stuff is doing, you know? So, I'm not going to call out any anybody's favorite munchies, but, they're not really so good for you. 00;37;03;24 - 00;37;20;29 Dr. Bertagnolli Okay, back to grandma's garden would be a whole lot better. So there's that, and there's how. But, you know, I'm being I'm being kind of facetious here, but but you know, there's also, you know, what is the best way because we have to feed everybody. We have to have a food supply. We have to have a food chain. 00;37;20;29 - 00;37;39;16 Dr. Bertagnolli And, you know, not everybody's going to have a garden in the backyard. So that's a big one, is food. And there's a whole initiative called Food is Medicine that we have across all of NIH. And that's one of those other overarching things, because every institute and center, everybody's interested in the Food is Medicine program. And if you want to, you can kind of look in there and see what's going on. 00;37;39;16 - 00;38;22;24 Dr. Bertagnolli So that's one we're doing. Another one is, boy, we learned a lot with these GLP one drugs. You know, these new obesity drugs. Why did we learn a lot. We learned that we thought it was just fixing somebody's metabolism so they weren't so obese. Guess what? They had fewer heart attacks. They survived a heart attack. If they got one, they were, believe it or not, the National Institute on Drug Abuse has data showing it's easier for them to, once they rehab from drugs to stay off drugs even because the it it's about this thing that's driving us to eat too much is similar to all of these kind of craving behaviors. 00;38;22;24 - 00;38;57;00 Dr. Bertagnolli Who knew? And so now there's lots of work that intersects with the drug, drug abuse, you know, research and mental health research, community and substance, you know, substance abuse and, and obesity, and learning that, you know, conquering our metabolic or getting our metabolic, part of our body into the right, right way is has effects on all of so many different diseases. 00;38;57;07 - 00;39;19;19 Dr. Bertagnolli There's lots of research going on there. And then, you know, I think we'll we're going to see more and more of this very quickly. Let me just add, this is another area where I don't want anybody left out, because these drugs affect everybody differently. And everybody's life is different with regard to what led them to be obese too. 00;39;19;19 - 00;39;37;11 Dr. Bertagnolli It's very different. Your lifestyle, your community, your environment is very different and has an effect on this. So all of those factors have to be taken in place. But boy, the benefits if we get this under control are going to be tremendous. 00;39;37;14 - 00;39;56;06 Rudene Mercer Haynes I can't tell you how many questions are just coming at me from all directions, but I'm saying that I only have, like, a minute. I'm sorry, but I just want to plant a few seeds and maybe you might respond to it in the chat. But one question again, I'm just going to rattle them off and you can just decide which one you're going to take. 00;39;56;06 - 00;40;13;02 Rudene Mercer Haynes Okay? Okay. From Doctor Tossas who's all about data. If you know Doctor Tossas head of COE, she's all about data. She wants to know what initiatives are in the pipeline to enhance data collection methods that ensure small, underrepresented populations are adequately captured in research. 00;40;13;09 - 00;40;35;04 Dr. Bertagnolli Okay. Number one, I'm talking about okay, let me where I remember I was talking about getting these places, resources, you know, tiny little clinic in rural Wyoming where there's like one doctor and, you know, you know, a computer. That's it. That's part of the tools that care for health is bringing in. They're bringing and and it's not fill out all these forms and, you know, fax them to us. 00;40;35;04 - 00;40;57;23 Dr. Bertagnolli No, it is the electronic abilities to gather data. And it also goes to people, you know, wearing a Fitbit, you know, wearing it. And finally, remote people. Okay. Right now we have, we have some infectious disease problems in certain communities, in very remote communities that can't get into the doctor's office. What do we do? It's the Covid mentality. 00;40;57;25 - 00;41;16;06 Dr. Bertagnolli We send them a test, they do the test. They take a picture of it with their cell phone that goes to some remote doctor. They mail them their antibiotic, you know, or they mail them their Paxlovid for their Covid. You know, there's so many other things we can do to make sure people don't get out. But as we roll out those things, we have to get the data. 00;41;16;08 - 00;41;34;07 Dr. Bertagnolli And the last thing I want to say to a person who cares about data we can't do, we've spent too much time doing snapshots of people. People have a whole life, and what you did as a child matters when you get to be 80. And so that's the other approach we have is really taking people as their whole, their whole life. 00;41;34;09 - 00;41;53;19 Rudene Mercer Haynes That's awesome. This is supposed to be Lightning Round, Doctor Bertagnolli, but you're not doing that for me. But I have one more for you from Father Tolkien. I think it's a great question. How will the NIH track the progress within the community, and how can the faith communities be of help in rebuilding trust? You said that was critical, right? 00;41;53;21 - 00;42;02;21 Rudene Mercer Haynes But people trust their churches or their synagogues or wherever it is that they, right? So how can we be a help to you? 00;42;02;24 - 00;42;22;27 Dr. Bertagnolli Well, you are the pillar of the community, right? And so that when I said we're coming into the community and saying, what's your biggest problem? And how can we help you with that? Well, that's going to be the faith, faith based community that we're going to come to you and ask that question. You know, you will help answer that first question. 00;42;22;27 - 00;42;45;05 Dr. Bertagnolli We need to know. And and then once we get in there, we want to we need to work together. And, part of this figuring out how that how that can happen in a sustained and really thoughtful way is part of this pilot phases of the whole care for health thing in the first place, because it can't. The other thing about trust is it can't be one and done. 00;42;45;05 - 00;42;56;05 Dr. Bertagnolli It's got to be every single day, every single new sign. We have to make sure that, we're there and have an enduring relationship. 00;42;56;08 - 00;43;13;19 Dr. Winn You know, I got to say thank you for that. And, I think, I hope everyone now knows there's my phone is blowing up and all these other things about, you know, other people sort of saying, can we have our back and we'll get to that later. But but I want to say thank you for sharing your time with us. 00;43;13;21 - 00;43;30;05 Dr. Winn It's been special. And in fact, I think that everyone on this call and everyone that participated now understand why, when I talk about that, we have great leadership at the NIH and I talk about, you know, I'm glad that they've got the experience that for themselves. So thank you so much. 00;43;30;05 - 00;43;38;01 Dr. Winn I know we're at the end. I'm hoping that, doctor, Bernoulli, that this is the beginning of a relationship. 00;43;38;03 - 00;44;02;10 Dr. Winn You will have a community. And I've gotten in my chat right now, Mike, but by text that we're going to do more than pray for you. Just tell us how we can help. That's that that's coming from that's coming from that fact. That's what this group is. And so, as we talk about community voices, as we talk about championing and getting the word out about science research, NIH, and how it's impacting community, you can count on us the Facts and Faith Friday crew to support that. 00;44;02;12 - 00;44;02;29 Dr. Winn I know we're