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;27;25 Dr. Winn We're going to talk today a little bit about the Bristol-Myers Squibb program and the foundation. And one of the biggest things that I'm really interested in is really just to start off with, how did you get in the medicine to begin? 00;00;27;26 - 00;00;48;02 Dr. Silvera So my path to medicine was a little bit circuitous. So I initially started my academic work as an English major. I studied literature and stuff like that with this kind of idea in the back of my head. I wanted to do medicine, but didn't have a real plan of how to do that. And then I finished my undergraduate training and didn't really know what I wanted to do. 00;00;48;02 - 00;01;15;16 Dr. Silvera So I actually ended up working in clinical research, and I fell in love with clinical research. They really kind of wedded my love of like stories and kind of taking individual stories and kind of finding the essential truth of those stories and weaving together into some sort of larger truth that may apply to a whole population. So it kind of let me find a way with that kind of English major mindset, to kind of make medicine into a story that could be used to help multiple people and that kind of find my way back to medicine that way, particularly the care of people with HIV. 00;01;15;16 - 00;01;17;17 Dr. Silvera That's how I got back into medicine. 00;01;17;19 - 00;01;27;21 Dr. Winn And that's awesome. Now, explain to me a little bit about, a little bit more about the HIV. HIV cancer's that, that, that sort of link. 00;01;27;23 - 00;01;49;10 Dr. Silvera Well, I got into the care of people with HIV because I was really drawn to the complexity of their care, not just the medical complexity, but the social complexity, the political complexity that all patients with that, with that illness had all those kind of things going on or were in them surrounding their care. And that kind of really attracted me because of the of all those multiple things interacting with people at that doctor patient relationship. 00;01;49;12 - 00;02;05;11 Dr. Silvera And then as part of that, I always kind of looked at medicine to a primary care lens. I really wanted to take care of people because part of their lives kind of take care of them over a long period of time. Another got into, HIV primary care. I learn more and more about the the toll of anal cancer among people with HIV. 00;02;05;17 - 00;02;23;27 Dr. Silvera This is really I think it was affecting all people with HIV, regardless of their wherever the kind of life they were living or cancer, the exposures in the past, there's a much higher rate of anal cancer in people with HIV. And it was so common, though, something that really needed to be addressed in primary care. And so that really kind of made the like off in my head because I love research. 00;02;23;27 - 00;02;36;13 Dr. Silvera I also love primary care. And, and this kind of what did all the things that interested in medicine all together one thing. For people with HIV doing so in a primary care setting and trying to, you know, do preventive medicine, can keep people living longer. 00;02;36;15 - 00;03;01;15 Dr. Winn You know, I'm glad you said that. You know, and it's interesting for me how you sort of weave that sort of complexity of people, right, in the communities and the various issues that are actually, happening within them and bringing them closer to actually having the therapies that would actually be able to impact their lives favorably. You know, I was thinking about, you know, how the treatment has changed for anal cancer recently. 00;03;01;15 - 00;03;23;10 Dr. Winn As we started thinking about the new blockbuster study that kind of came out with the, you know, as you know, the, the new immune, cancer initiated or, you know, immunotherapies that we actually have and showing that, you know, in some types of, with certain mutations and things like that or rectal cancers, you may not even need surgery anymore. 00;03;23;16 - 00;03;37;07 Dr. Winn Can you comment on the evolution, from when you started to, in your treatment right now of how you think anal cancers are being treated before now, but what's your hope in the future when it comes to anal cancers? 00;03;37;10 - 00;03;57;28 Dr. Silvera Well, I think the kind of my big hope is as there's been great innovations in treatment for anal cancers. But I think that ideally what I really what I'm focusing on is prevention. I think like an ounce of prevention is really worth, worth a pound of cure. While they've been great strides in treatment and, you know, modalities, having less invasive treatments with better outcomes. 00;03;58;01 - 00;04;24;13 Dr. Silvera So I would rather prevent the cancer from happening in the first place, if I could. And that's really the goal of my research right now. So what we've got have had some strides in anal cancer screening throughout my in my career because it's really kind of the there's a lot of new innovation happening in that field. So, since I've kind of entered into this, built this world of research, we've, we are working to kind of protect our ways of screening for anal pre cancers that we can then remove those cancers before they become anal cancer. 00;04;24;16 - 00;04;43;26 Dr. Silvera And that approach has been validated recently. In the anchor trials, the large multi-site trial, we showed that removing pre-cancerous actually as we tried to effectively prevent cancer from developing. So that's great. That's wonderful. That tells us we have a way prevent these cancers from happening before we have to worry about treatment outcomes. But the thing is, we have to find those precursors before we can treat them. 00;04;43;29 - 00;04;48;03 Dr. Silvera And that is what my research is looking at the newest to find those anal for cancers. 00;04;48;05 - 00;05;05;24 Dr. Winn So as you start thinking about how to find them, it actually, you know, it depends on two, one, two, two things, right? The technology and the ability to sort of find them. But it also depends on the community and their trust for them to be participants. So how are you addressing that issue? 00;05;05;27 - 00;05;23;20 Dr. Silvera Absolutely. I mean, we can have the most amazing technology in the world if people don't trust you enough to come to your clinic to receive that technology, it's pointless. And I think that particularly the populations that are have a heavier burden of anal cancer, there's a lot of, you know, very justified systemic distrust in those communities of medical establishment. 00;05;23;23 - 00;05;43;07 Dr. Silvera There are there's they're high rates of, you know, cancer from people with HIV, higher rates of anal cancer and cancer outcomes among among black populations as well. Both these communities have a lot of well earned medical distrust. And that needs to be overcome, actually overcome by the providing care, or else no matter how they felt, there's no one to be there to receive it. 00;05;43;10 - 00;06;00;14 Dr. Silvera And so I think that I think there are many ways we can address. I think, first of all, just who is doing this research? I think we need to have more diverse, research professionals, not just physicians, but, you know, research assistants, aids nurses, all these people. We have to be members of the committee that are caring for it, because I think that that is a lot of things. 00;06;00;14 - 00;06;14;15 Dr. Silvera First of all, it gives you a common language to speak to your patients about, you know, yes, you can you can try to connect with people who come from different backgrounds than you do. But if you have that common experience, that's really that's a that's a or a quick entry into a shared language, that person, a shared experience. 00;06;14;15 - 00;06;32;15 Dr. Silvera I think that really it's hard to duplicate other ways. I think it also lets you bring the concerns that community into the planning room, into the research of the, the research protocol development room lets you think about, well, what do these people care about? And can we represent those cares in what we design this trial when we recruit for this trial, when we think about how the trial is going to be set up. 00;06;32;17 - 00;06;43;24 Dr. Silvera And I think that there's some things that are just really hard to know. By reading a paper, you have to really live that life. And we need to have people with those experiences in those rooms. When we develop these trials. And so I think diversity of the workforce also be really, really important. 00;06;43;26 - 00;07;08;04 Dr. Winn And that's hot. So as you start thinking about that in the context of diversity, the workforce impact in the community, when I think about clinical trials, I think of the legal design and implementation. But up until recently there hasn't really been an emphasis on the attention that's needed about the outreach and engagement for the community, about even integrating the social determinants of health. 00;07;08;11 - 00;07;28;21 Dr. Winn So can you tell me how that evolved for you? And an example is, you know, I know you're part of the, you know, the Robert Winn Scholars program, you know, can you can you, you know, sort of, talk about that a little bit more about where you think trials are, but where you think ultimately trials can go. 00;07;28;21 - 00;07;30;11 Dr. Winn And the development of those trials. 00;07;30;14 - 00;07;36;25 Dr. Silvera So I, I've been fortunate enough to be one of the first recipients of the Robert Winn Diversity in Clinical Trials Program. 00;07;36;28 - 00;07;44;18 Dr. Winn I'd argue would be actually other than, actually benefiting from your actually getting out there doing it. But, you know. 00;07;44;21 - 00;08;03;25 Dr. Silvera So, so but so, you know, good luck on both sides. But I'm part of the initial cohort. I think that this program really kind of does two major, kind of the two really, really important, I think, things I think for the success of these kind of studies. Firstly, I think from the investigator perspective. So like from, for me being a young investigator kind of learn the ropes of this world. 00;08;03;27 - 00;08;25;07 Dr. Silvera I think a lot of those things that are not needed to know to be a successful researcher, like you know, how to develop a research trial, how to for research question, how to write a manuscript appropriately. All of those things are necessarily taught in classrooms. They're kind of a shadow curriculum that you kind of have to learn from the people around you and people from diverse backgrounds may not have access to those shadow curriculum. 00;08;25;07 - 00;09;02;26 Dr. Silvera So those networks. So I think creating an infrastructure to get that information to people who may, depending on their environment or their connections, may not have access to that is going to be really important for getting them entree into the places they'll need to to do really important research. So I think that's really important. And then secondly, I think that the focus on actual tangible skills and thinking about critically of how to engage diverse communities, how to build medical trust, how to, bring clinical trials into nontraditional settings to try to meet patients where they are, to think about that critically and how that aligns somewhere on a slide that's just going to breeze over, 00;09;02;26 - 00;09;19;26 Dr. Silvera but actually be something worthy of discussion and focus is a really important skill to do research on. People who are often excluded from research because research structures are not built to, to, to, to care, to cater to them. And so learning how to leverage those resources you might get as a junior researcher to engage is so often overlooked. 00;09;19;26 - 00;09;27;25 Dr. Silvera I think it's going to be really important for getting more people involved in the research on both sides, both as a patient as as well as the as the investigator know. 00;09;27;25 - 00;10;01;16 Dr. Winn Thank you for that. And that brings up a really good point. A follow up question for me in the context. You said something that really resonated, right? It is building trust. And so as you're thinking about, that and the importance of that, of, various communities, African-American communities, right? Latino communities, LGBTQ communities there with the health system have been, I wouldn't say so much distrust in some cases, yes, in some cases mistrust, but certainly low trust. 00;10;01;18 - 00;10;25;00 Dr. Winn So how can you and your project, what element of that are you trying to figure out how we can, as you as an individual, help to build more trust, but then actually transition that into if this program were to work, and everything hits, how can our institutions become more trustworthy? 00;10;25;02 - 00;10;40;17 Dr. Silvera So I think, I mean, I if I had the answer to this question, I would be, you know, on a world tour. But I think I have some ideas of how to work towards this. I think kind of the first step is just showing up and being present and being present, not just when it's helpful to you, but being present consistently. 00;10;40;20 - 00;11;14;00 Dr. Silvera And I think that in the world of research for funding, maybe temporary or things like that, that can be really tough to accomplish. And I think having a a and I think that's one thing that is with the Win program is addressing, is that having it be a continuous stream of researchers from these communities interested in this community is being present in these communities, I think can create a continuous research presence in these communities that will then be a step towards proving that you're not just there to exploit that community for a particular research question, and then take your pick your data and going there to actually invest into long term solution building for these 00;11;14;00 - 00;11;33;14 Dr. Silvera communities. And I think having and not just be, you know, one person's random research question, but to have it be a structured thing where there's going to be continued investment, continued presence, multiple research questions, that kind of building and infrastructure research in these communities. I think it's going to be a step towards building that trust because, you know, it takes generations to build trust, and you can't just do it in one afternoon. 00;11;33;17 - 00;11;37;25 Dr. Silvera And having a commitment from institutions to make that investment. I think this will be really important. 00;11;37;27 - 00;11;56;27 Dr. Winn And I appreciate that. Changing gears just a little bit is, you know, this is, in the history of, doing the Black History Month. If you, could pick out an historical figure, if you would, that actually continues to inspire you to this day, who would that be and why? 00;11;56;29 - 00;12;04;01 Dr. Silvera Oh, that's a tough one. Wow. I really only get one. 00;12;04;03 - 00;12;06;19 Dr. Winn And you'll get one. 00;12;06;21 - 00;12;29;17 Dr. Silvera I mean, I think history is such a tough thing because in many ways, I think kind of the experience of being, a, a minority in America, you kind of get divorced from your own history. And so, it kind of has this kind of disconnect where I just really feel like it's your own. But I would say that, I think something a little controversial. 00;12;29;23 - 00;12;45;17 Dr. Silvera So. And one thing I this is something I learned about more recently in my life, but I think there's proximity to my experience is actually really important. So I did my residency training in the Bronx here in New York. And as part of that, we learned a lot about the history of the Bronx, on the history of health care in New York City. 00;12;45;19 - 00;13;08;15 Dr. Silvera And one thing that I had never heard about before during my training were the Young Lords, who were a a group of revolutionary, Afro-Latino, service in East Harlem. And, you know, you're kind of very inspired by the Black Panthers doing a similarly similar sort of, you know, revolutionary work. But the thing that they were able to accomplish for their community is really inspiring. 00;13;08;17 - 00;13;25;15 Dr. Silvera And I think the thing that I draw from that is like, I live across the street from where they're, we're where their headquarters used to be. So I walk by it every day. But to think about that, they really came from nothing and were able to and is able to by commitment to the community and by, you know, being innovative and being dedicated to what they're doing, able to accomplish so much. 00;13;25;15 - 00;13;42;02 Dr. Silvera We started with so little. And this reminds me, you know, as a junior researcher, I feel like, oh God, I have no funding. I don't have any money to do this thing. So it's like, you don't need money, you just have to try. And even trying is more than half the effort. So I think I can take inspiration from them that they were able to build so much can have such a lasting impact with so little to start. 00;13;42;04 - 00;13;53;03 Dr. Silvera So, you know, I'm like, well, I may not be a have a multi-million dollar research budget, but so that I can accomplish something for this community, even if I'm because I'm doing pretty good and I can do something with what I've got and that I can graduation from that. 00;13;53;05 - 00;14;35;00 Dr. Winn In fact, I think you bring up a good point that sometimes we, when we go back, we don't really fully recognize the impact of some of really the community activators. Right. And the community activists. And if you go back in history, you know, in the context of having people from those communities being interested in people within those communities for the good of those communities was something that happened in the 50s and 60s that, again, manifests itself differently today in the context of, you know, for example, folks who were saying, why can't we get health and science closer and open to our communities in that context, what is the long term impact 00;14;35;02 - 00;14;48;04 Dr. Winn that you're trying to achieve? With both the research and after completing this program. So when you say, when will you know that you've been at least somewhat successful? What does success look like for you? 00;14;48;06 - 00;15;08;20 Dr. Silvera Well, I think success is going to take a lot of many different forms, and I think that participating in this program and doing this research, in letting you kind of engage with success in a few different ways. So firstly, this this program is the kind of nurturing my research friend trying to get me to take to get those first steps taken to be an established independent researcher, to be able to do this, to address these research questions. 00;15;08;22 - 00;15;25;21 Dr. Silvera But let me be the one who designs the questions. Let me be the one who asked. Decide how those questions will be asked, because I think that advocacy can be built into research questions if you ask the question correctly. And so I really would like to be a fully formed independent researcher, so I can have the ability to form those questions and ask those questions. 00;15;25;24 - 00;15;40;11 Dr. Silvera So I think that's one form of success. And I think that this program is well poised me to be able to do that by letting me get my get my feet off the ground and start moving in the direction to gather data, get some research. Some research accomplished to show that these things are worthwhile and demonstrate that. 00;15;40;14 - 00;15;57;10 Dr. Silvera But secondly, I think part of success is also building a legacy and not just have to this being an island, but, you know, having an influence on the next generation and things like that. And, and I really do one thing that attracted to this program was that there was a mentoring aspect of and to work with that with a medical student. 00;15;57;12 - 00;16;12;22 Dr. Silvera And so I think that that has created a, a network where there will be 2 or 3 years from now, a new round of researchers who have already gotten their taste for this will then come in to be able to take over these studies, be my junior researcher, the the fellow I work with to work on these next steps. 00;16;12;22 - 00;16;27;10 Dr. Silvera So I think that that is also a mark of success to not just be one person doing it, but the beginning of a community of people doing something. And I think that this is going to be a step towards doing that. It's not. The other stuff happens in isolation, but I don't want to just be one researcher out of an island by myself. 00;16;27;10 - 00;16;44;16 Dr. Silvera I want to be part of a community of researchers doing this kind of work. And I think that this is a step towards that. All the other people I've met in this program, the network that we've been able to develop already, some great collaboration that is from from that. So I think, again, just being part of the community of researchers who care about these issues, focus on these issues and make these a fundamental part of the research questions that we ask. 00;16;44;19 - 00;17;12;23 Dr. Winn And I love that, you know, so, you know, that's, you know, really, I mean, I think of empathic response as I think about this, I think about how it must feel for you to know we usually talk about pioneers as being someone else. This program is unique in that it's pioneering, bringing together the sort of design implementation and bringing in this awareness of the community. 00;17;12;25 - 00;17;18;23 Dr. Winn How does it feel to be part of a program in which you're pioneering or trying to blaze new paths? 00;17;18;26 - 00;17;44;08 Dr. Silvera Well, I would I mean, I would say that, actually feels really like like this is a coming home in many ways. I mean, I think this can be the first day we met all the other, members of other people who are part of the program and just to have other people who really were passionate about the same things that you were passionate about and cared about the things that you cared about and you know, were upset or, you know, energized about the same things that had seen in the news or read. 00;17;44;11 - 00;18;11;05 Dr. Silvera And it's like that felt really comfortable, like it felt it felt like you'd come. You found that you found your people. And so while it was pioneering, it also felt really comfortable. It felt like it felt right. And so it doesn't. So it's been surprisingly easy to be able to do this. It's been great to find those other researchers out there in a similar kind of working the same world, but having that other, other interest in advocacy and equity and stuff like that, has felt really, really, really like comforting and great. 00;18;11;12 - 00;18;13;27 Dr. Silvera So it's been really easy to be a pioneer in that regard. 00;18;13;29 - 00;18;32;03 Dr. Winn Then I'm going to come through and give you a zoom of and I mean, so last question, what would you like to tell future applicants of the Bristol-Myers Squibb Foundation's Win awards program if you had any advice for them? What would that be? 00;18;32;05 - 00;18;51;09 Dr. Silvera I would say kind of the biggest advice would have, I would have is to bring your whole self to your research and not to feel like you have to cut yourself away or cut parts of your personality or parts of your history, or parts of your interests that you think are not what a researcher is supposed to be, or what supposed research was to look like, or what kind of questions was to care about. 00;18;51;11 - 00;19;06;19 Dr. Silvera I try to edit those out of you are out of your self when you present yourself professionally. I think that this I would urge you to bring your whole self, bring all of your experiences, bring your whole history, bring all the things you've experienced, both positive and negative, the questions that you asked to the applications that you present. 00;19;06;26 - 00;19;21;14 Dr. Silvera Because while you may have been kind of subconsciously told that those things aren't valuable, but they are valuable in certain places available here, and I think that this is a place where I would encourage you to bring your whole experience and your whole self the questions you asked, because they want all of you, not just the people writing. 00;19;21;14 - 00;19;25;21 Dr. Silvera Part of you want that. They want everything. And so I think I would encourage you just bring your whole self to application. 00;19;25;24 - 00;19;46;17 Dr. Winn And I appreciate that. And that's, you know, part of this, sort of mission we have hopefully with the program to move and pursue always academic excellence, but to actually move toward something in our pursuit of excellence that we actually move towards academic relevance and it's relevant to us. It's relevant to the communities we serve. So listen, this has been fantastic. 00;19;46;17 - 00;20;04;11 Dr. Winn And, one, I appreciate you taking the time out, to be able to talk with us today, and be able to reflect not just on the program, but reflect on really what it is that we're all trying to do, particularly during this particular month, of making sure that our communities are impacted not only today, but every day. 00;20;04;18 - 00;20;14;28 Dr. Winn And I want to take my hat off to you. I think from my perspective, my last question, is there anything else that's on your mind? 00;20;15;00 - 00;20;28;06 Dr. Silvera I mean, I guess just, happy black students, everyone. And I hope that we can continue moving upward and forward. Yeah. Other than that, you know, just to keep plugging away every day, no matter how dark things look, things are getting better slowly. It's gotta keep working at it. 00;20;28;09 - 00;20;58;04 Dr. Winn Gotta keep working at it. Berlanti, Berlanti. Okay. So listen. Appreciate you. Thank you for taking time. And, and, again, keep up the good fight and, you know, keep blazing the trails and, again, great work. And I am so proud, to and honored to be able to, you know, know that I know you, man, as you were starting to to do these things through this program, there's, you started some good things and and some even greater things for you to accomplish. 00;20;58;04 - 00;21;03;03 Dr. Winn And it will get done that, absolutely confident. Appreciate you. 00;21;03;05 - 00;21;06;20 Dr. Silvera Well, thank you, doctor, and I appreciate you as well.