00:00:00:15 - 00:00:07:18 Dr. Winn I'm Dr. Rob Winn and you're listening to Real Cancer Talk from VCU Massey Comprehensive Cancer Center. 00:00:07:20 - 00:00:44:10 Dr. Winn Doctor Brawley, it is an absolute pleasure, and an honor, sir, to be able to interview you for this portion of the cancer letter, where we're going to get to talk about some of the giants in the field, particularly during this upcoming month of February, and reflecting on the impact that we as a community have had. I don't know that you even need an introduction because I think everybody knows you, doctor, I swear to God, I mean, we know you and what you did in the context of when you were VP at, American Cancer Society, your early work at NIH. 00:00:44:12 - 00:01:09:24 Dr. Winn And also the work that you currently are doing, amazing work in the context of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. So I'm going to get things started with a question that, I don't know if you've gotten asked before, who actually and how were you inspired to follow a path of science, or how did you even think about becoming a doctor? 00:01:10:04 - 00:01:12:18 Dr. Winn Who was it? Your grand...who was it? 00:01:12:20 - 00:01:42:22 Dr. Brawley That's interesting. It's interesting, by the way. It's it's humbling to be interviewed by a giant such as you. I will tell you that growing up in Detroit, my father worked in the veteran's hospital and janitorial service. My mother, when I was very young, was actually working in the food service at the same hospital. 00:01:42:24 - 00:02:22:05 Dr. Brawley Growing up, I was always encouraged by teachers to, think, to express myself. I was always led to believe that I could do things. Unfortunately, many of the colleagues in the inner city, many of my colleagues or the guys that I grew up with in the inner city of Detroit, grew up thinking that they could not and then my parents, were the exact opposite, neither one having graduated from high school. 00:02:22:07 - 00:02:55:24 Dr. Brawley I can remember in 1970, when I was 11 years old, the census taker came to the house and actually sat on our couch and was and we and asking, asking my father these questions about the family and she at some point in time (she was a black woman), at some point in time expressed surprise that my father expected me to go to college. 00:02:56:01 - 00:03:00:21 Dr. Brawley He got so mad he almost threw her out of the house. 00:03:00:23 - 00:03:01:12 Dr. Winn Wow. 00:03:01:13 - 00:03:23:22 Dr. Brawley The idea that I would not go to college was just not acceptable. And then, along the way, I was very fortunate. I had a number of teachers, the Catholic school with the sisters of the Immaculate Heart of Mary, who ran the grade school that I was then, always very encouraging. 00:03:23:24 - 00:03:53:12 Dr. Brawley Some of the lay teachers who were working there as well, always very encouraging. Sister Clara Elizabeth, who was a very good friend of my mother's, who told me and told my mother and father that I needed to go to the Jesuit high school. That's where all the smart people go. And, Sister Clara Elizabeth actually called the Jesuit High School and told them, this kid needs to go there and ultimately arrange for me to have a scholarship to go there. 00:03:53:14 - 00:04:24:07 Dr. Brawley Man named John Cole up in Alpena, Michigan. He was University of Detroit Jesuit High School class of 1939. Paid for my tuition from 1973 to 1977. Then once there. The Jesuits actually don't teach you what to think. They teach you how to think. And there's number of Jesuit priests, and lay people there who encouraged me to go do things. 00:04:24:07 - 00:04:47:17 Dr. Brawley I'll never forget, Father Polakowski who I actually write about in the book that we're going to be talking about. Father Polakowski, I once wrote, he had these 30 minute essays you had to do with pencil. And on the back of, used mimeograph paper, if you remember the mimeographed. 00:04:47:19 - 00:04:48:07 Dr. Winn Oh, my God... 00:04:48:07 - 00:04:52:08 Dr. Brawley He give you a subject and you had 30 minutes to write about it. 00:04:52:10 - 00:05:11:12 Dr. Brawley I wrote one essay one day, and at the top when I got it back, he said, rather than grade this Otis, I'm going to tell you, there are vacant dormitory rooms at Eastern Michigan University. Green and White. Fight, fight, fight. 00:05:11:14 - 00:05:13:03 Dr. Winn And that's. 00:05:13:05 - 00:05:31:13 Dr. Brawley And, sorry for people who went to Eastern Michigan, but that he, he was a snob about colleges. It was Father Fallen and Father Polakowski who told me I needed to go to the University of Chicago and... 00:05:31:13 - 00:06:14:09 Dr. Brawley And so I was guided by a number of wonderful people in high school, after the nuns in grade school, after my father before them, my mother and father before them, who once in college, I ran across a number of people who again, were very supportive. Couple of people. Elliot Keefe, who is an infectious disease doc. He, found me when I was in second year of college and decided he he lobbied me for a long time to go to medical school. I was going to go to graduate school in chemistry. 00:06:14:11 - 00:06:14:13 Dr. Brawley So. 00:06:14:14 - 00:06:19:08 Dr. Winn You were going to go in the University of Chicago for that, or were you just University of Chicago bound? How did you? 00:06:19:10 - 00:06:42:23 Dr. Brawley I was University of Chicago undergrad, and I would go on. Yeah. I didn't know where I was going to go to graduate school at that time. One of his friends, Jonathan Fanton, who was a vice president, for fundraising, also got very involved in encouraging me and, you know, Mrs. Clinton once wrote a book called It Takes a Village. 00:06:42:23 - 00:07:12:03 Dr. Brawley And, you know, I, I was the product of black, actually, some black inner city gang people even tried to help me out. Nuns, Fanton is a WAAST, Elliott Keefe is a Jew. It was a huge village of people who supported me over the years in doing things. When I say gang people tried to help me out, I think that's worth telling. 00:07:12:05 - 00:07:40:13 Dr. Brawley You know, there in, growing up in the inner city of Detroit, there were, a whole bunch of folks who had very little hope. And there were some people who were in the West Side gang, the BKs, the black killers who felt I was trying to make something of myself. So I got protection from them because I was trying to help myself. 00:07:40:16 - 00:07:43:05 Dr. Winn Wow. 00:07:43:05 - 00:08:08:13 Dr. Brawley And so that's that's really how it started out. Once I got to medical school, and Keefe pushed me toward going to the University of Chicago, I met, a man named John Altman. John Altman was one of the original oncologists. He's actually behind the original staging systems in the 1950s. If you go way, way back. 00:08:08:14 - 00:08:35:11 Dr. Brawley He's also one of the creators of the, chemotherapy regimen called CHOP. He was. He called himself a lymphomaniac. He was a lymphoma expert. John Altman, he was also a member of the overseas Secret Service during World War two. He was a spy. He came back, he went to Oberlin for college in Columbia P&S as he called it, for medical school. 00:08:35:11 - 00:09:10:14 Dr. Brawley They used to be called Columbia School of Physicians and Surgeons. And then he, trained in internal medicine and hematology. And he's one of the people who brought solid tumor oncology into the world in the 1950s, 60s and 70s. John encouraged me. He was also, by the way, the first chair of the National Cancer Advisory Board, when they... National Cancer Act came about and he had a number of friends in oncology, he encouraged... I was interested in policy. 00:09:10:16 - 00:09:28:06 Dr. Brawley I was, more interested in law and policy early on and then oncology. And then I was interested in science, and he convinced me there was a lot of policy and science in oncology. And that's how I ended up pursuing oncology. 00:09:28:08 - 00:09:48:06 Dr. Winn Thank you for telling me that, because I was thinking in that era, it was still I mean, cancer was not as curable as it is today. So what would drive you into a field that honestly, it was still like bare skins and sharp knives back then about how do you cure cancer? 00:09:48:08 - 00:10:23:01 Dr. Brawley We're talking, we're talking in the 1980s. Yeah. And, you know, there were almost no drugs approved for cancer between 1980 and 1992, 93. There was a lot of hope. But John led me through this. John actually saw, both, hope and treatment as well as he he always felt that, you know, even though he's a lymphoma doc, and he actually cured some patients of lymphoma, with the chemotherapies of the 1960s, 70s and early 80s. 00:10:23:03 - 00:10:51:14 Dr. Brawley He always felt that prevention needed to be stressed more. And, he was also very much, rigorous orthodox scientist. And, and that's the reason why I have some of my orthodoxy to this day. Some people get upset when I, you know, start telling people some scientific truths and start saying, we need to stop being gunslingers and coming up with these treatments and screening and so forth. 00:10:51:14 - 00:11:18:10 Dr. Brawley And we need to be very orthodox and practice with the science says. And so John, guided me through, medical school residency. He even told me where he wanted me to interview for fellowship and, gave me nine places to go interview for fellowship and said, as you go to them, I want you to rank them one, two, three, four, so forth. 00:11:18:12 - 00:11:42:08 Dr. Brawley And after you've gone to each one, rank them. And then once you've been to all nine and you will get interviews at all nine. Call me. And so I went to all nine places. I called him up one day and said, I want to go to and I will not mention the institution for obvious reasons. And he said, Otis, if you go there, I will never speak to you again. 00:11:42:10 - 00:11:44:13 Dr. Brawley This in his Austrian accent. 00:11:44:15 - 00:11:45:24 Dr. Winn No way. 00:11:46:01 - 00:12:06:01 Dr. Brawley And I said, but you told me I should interview there. He says, I wanted you to visit there. I wanted you to meet the people there. I don't want you to train there. And I said, well, in that case, I guess my first choice is the National Cancer Institute. And he says, Otis, where will you be tomorrow afternoon? 00:12:06:03 - 00:12:43:02 Dr. Brawley And I said, well, I'm doing an intensive care rotation. And he said, how can I get ahold of you? And I gave him my pager number. The next afternoon, I get a, I'm actually coding a patient in the intensive care unit. And remember, we used to have secretaries at every ward? So the ward secretary has my pager. And after the code is over, she tells me that this doctor, Sam Broder from the National Cancer Institute called, and wants me to call him back. 00:12:43:04 - 00:13:07:17 Dr. Brawley And so I called him back. Sam became a very good friend of mine later on, and Sam says, I'm calling to offer you a job at the National Cancer Institute as a fellow, and I accepted immediately. And then I called John and called Doctor Altman, and he said in his Austrian accent, Otis, I have been expecting this call. 00:13:07:19 - 00:13:31:11 Dr. Brawley And I said, thank you very much. And he said something that has stuck with me since that phone call in 1986. He said, Otis, I want you to realize that medicine is an old boy's club. You will thank me by getting more women and blacks into the club. 00:13:31:17 - 00:13:33:08 Dr. Winn No way. 00:13:33:10 - 00:13:45:16 Dr. Brawley And that was in 1986. And that's when I realized that every place I went to to interview, I interviewed with the director of that cancer institute. 00:13:45:18 - 00:13:49:06 Dr. Winn Wow. Wow. 00:13:49:07 - 00:13:51:05 Dr. Brawley He really set me up. 00:13:51:07 - 00:13:52:03 Dr. Winn Wow. 00:13:52:07 - 00:13:59:04 Dr. Brawley And, and, and so that's how I ended up at the National Cancer Institute. 00:13:59:06 - 00:14:15:08 Dr. Winn So while you were there at the National Cancer Institute, just thinking out loud. So there's certainly you, but I've heard stories that there were other luminaries that may have been your classmates around, you know, around that same time that were just troublemakers. Not to say that you were. 00:14:15:08 - 00:14:47:02 Dr. Brawley Oh, yeah. Yeah. Well, Steve Hahn, who became FDA commissioner, was, one of the fellows with me. A number of the people who were just ahead of me, have become cancer center directors. Kevin Cullen, Doug Yee. They're number of cancer center directors. We've had, a lot a lot of fun. 00:14:47:04 - 00:15:16:00 Dr. Brawley We still get many of us still get together and talk about the good old days. You know, when I got there, Vince DeVita was the director, and he would come and round with this on Friday mornings. You like Gladstone, the radiation oncologist who always told us he was the best medical oncologist at the NIH. And, actually, about about three months into your fellowship, you started realizing that Eli Gladstone was at the best. 00:15:16:02 - 00:15:17:07 Dr. Brawley You know. 00:15:17:09 - 00:15:43:00 Dr. Brawley John Miano was a branch chief, and he's been a very good friend and and very good supporter and, I make friends with Barry Kramer, who's been important to me for the rest of my life, who again impressed that orthodoxy. You read the study, and you apply, as the study says, and you realize what things, are, right. 00:15:43:00 - 00:16:06:06 Dr. Brawley And what's wrong. Father Polakowski, when he heard I was going to medical school, called me up and, later put in a letter that I still have. And he said, I want you to remember that there are things that you know, things you don't know and things that you believe. 00:16:06:08 - 00:16:28:14 Dr. Brawley And you need to always try to figure out, is this something I know? Is this something I don't know, or is this something I believe? And then he said something very important. He said, remember that doctors have this incredibly bad habit to confuse things they believe as things they know. 00:16:28:16 - 00:16:46:23 Dr. Winn Oh man. That is one that...You know, so I actually am thinking about what you're saying, and I'm wondering how much of that framework made up the inspiration for your book. 00:16:47:00 - 00:16:47:10 Dr. Brawley Yes. 00:16:47:10 - 00:16:58:11 Dr. Winn That you co-wrote with...and it's the How We Do Harm, which I'm telling you, I...Now, Dr. Brawley, I want to let you know I still have the copy that you're supposed to sign. 00:16:58:13 - 00:17:17:12 Dr. Winn So at some point, we're going to get that done. But that book, in particular, I think has been a high impact book. I mean, I've read it. There's some amazing things, and I'm starting to put two and two together. How important was that as the catalyst for the book of How We Do Harm? 00:17:17:16 - 00:17:51:11 Dr. Brawley It was it was incredibly important. One of the things that we realized is in medicine, there's a lot of what I call gunslinging as you're making it up as you go. And to go full circle, you know, growing up in the inner city of Detroit with people who were not highly educated, some of whom were actually quite wise, but not highly educated, I started realizing in medicine, a lot of people think that folks, like that, are not very wise. 00:17:51:11 - 00:18:20:02 Dr. Brawley They don't realize that many of those folks actually realize that doctors are frequently making it up as they go along. And, some of what I hear about, inner city poor people, black people thinking that doctors are experimenting on them is actually those folks realizing that some doctors are making it up as they go along, and that truly respecting the science. 00:18:20:04 - 00:18:49:11 Dr. Brawley So that's part of the reason, part of the motivation for writing the book. And the book is a series of experiences that I have had over time, good experiences and bad experiences showing where doctors have gone wrong by not being, you know, really orthodox. Patients have gone wrong by listening and believing some of the things that they have heard. 00:18:49:13 - 00:19:16:04 Dr. Brawley I even talk about how some of the foundations and some of the charities are out there, more trying to make money and in some instances, trying to get people to just believe and unfortunately, especially in the area of screening. And I ultimately under Barry Kramer trained as a, screening epidemiologist after doing medical oncology. 00:19:16:04 - 00:19:45:12 Dr. Brawley I did a whole bunch of cancer control stuff with Barry Kramer and Peter Greenwald. Those are big names. And, and and Joe Fraumeni. Those are big names in epidemiology and in cancer control. There are a bunch of folks who want to do things in screening that are actually wasteful of resources. They don't work. We don't know they work, but we do them anyway, and we waste resources. 00:19:45:12 - 00:20:14:18 Dr. Brawley And the other thing that came along under Kramer in the early 1990s and then working with Rick Klausner when Rick became NCI director, and working with David Satcher, who Rick introduced me to and David Satcher was Surgeon general, I was interested in, the fact that certain populations don't do as well as other populations. We used to call that, by the way, Minority Health, and for a time we called it Special Populations. 00:20:14:20 - 00:20:38:09 Dr. Brawley And I was actually in the room. There were about 12 of us in the room with the surgeon general at the head of the table, talking about how some politicians were against some minority health programs. And I swear to God, I thought the surgeon general was asleep at the time. And all of a sudden he says, why do we call it minority health? 00:20:38:11 - 00:20:55:17 Dr. Brawley Why don't we call it what it actually is? I want to see these politicians say I am against programs to reduce disparities in health. And a bell went off. That's when it started being health disparities. 00:20:55:19 - 00:20:58:01 Dr. Winn Wow. 00:20:58:03 - 00:21:20:09 Dr. Winn So so can you tell me in that context. So you've talked a lot in particularly in the book about, you know, what I loved you said things, you know, things you don't know and things you believe. Where did this impact then of the movement around evidence based medicine? Because that's happened somewhere. Where does the evidence based medicine sort of movement kind of come from? 00:21:20:09 - 00:21:24:20 Dr. Winn And and how were you, you know, interacting with that? 00:21:25:01 - 00:21:48:18 Dr. Brawley I was very lucky that as I was starting to be told by even Altman in medical school that you needed to be scientific and you need to be Orthodox. I did my residency at University Hospitals of Cleveland, at Case Western Reserve, and, you know, we had young people, there who were interested in internal medicine and evidence based medicine. 00:21:48:18 - 00:22:16:02 Dr. Brawley David Ransohoff, who still out there, he's a GI doc, but he does a lot of evidence based medicine. Seth Landefeld, who is chair of medicine at UAB, he was training there and and starting to blossom. But that's where my introduction to evidence based medicine was. And then evidence based medicine comes to oncology was at the NCI in the 1990s. 00:22:16:04 - 00:22:39:04 Dr. Brawley One of the most important things that Barry Kramer ever had me do is, you know, one of the things, and this is one of my new projects that I'm talking about, the National Cancer Act from 1971 puts the National Cancer Institute in charge of education regarding cancer, education of physicians, education of the community. It's in there. Not frequently. 00:22:39:08 - 00:23:04:05 Dr. Brawley It's the reason why there was PDQ. It's the reason why there was a cancer information service or cancer communications, as well as what it was called. And one of the things that Kramer made me do early in the 1990s was I had to read everything that was being published by PDQ about oncology. It was a great review for the board exam by the way. 00:23:04:07 - 00:23:33:00 Dr. Winn So picking up from that, as you're thinking in the context of, you know, back then, prevention, because, you know, one of the things I know about you is that certainly, I mean, you have been a proponent of the basic translational scientists, but this sort of focus on prevention. You mentioned Doctor Broder, who actually, I think famously said something about poverty... 00:23:33:02 - 00:23:34:10 Dr. Winn Yes, Sam Broder. 00:23:34:10 - 00:23:35:19 Dr. Winn Yeah, Sam Broder, right? 00:23:35:21 - 00:23:38:22 Dr. Brawley You know, it's interesting. Some people think I said that. 00:23:38:24 - 00:23:42:05 Dr. Winn I actually was going to say that you said that. 00:23:42:07 - 00:23:43:08 Dr. Brawley No. 00:23:43:08 - 00:23:55:20 Dr. Winn Because that is what I associate strongly with you. And then I did some digging before this, and I was reading the book and I was like, Sam Broder, oh, how did that happen? 00:23:55:22 - 00:24:31:16 Dr. Brawley By the way, many people don't realize that Sam Broder and Bob Yarchoan, when Bob Yarchoan is still active at the NCI, where the guys who developed the first effective anti-HIV drugs in the early 1990s, they shared their work in the 1980s, and they got AZT or Zaire voting FDA approved, and I believe 1990 or 1991. And actually, they did even a clinical study that ultimately framed my thoughts about minority inclusion in clinical trials, a lot to which we can talk about in a second. 00:24:31:18 - 00:24:46:21 Dr. Brawley But Sam Broder, who's a wonderful person who cares a lot about people, he's the guy who said poverty is a carcinogen. He said that when he was NCI director in the early 1990s. 00:24:46:23 - 00:25:10:13 Dr. Winn Wow. So as you started thinking about going in the context of being at the NIH and during that period of time, what was, you know, your biggest takeaway about the transition? Or where was maybe in the 60s and 70s and what it started being able to focus on. You mentioned that the context of health disparities and identifying that different communities, this is not a value judgment. 00:25:10:13 - 00:25:31:09 Dr. Winn It's a scientific sort of term. Two communities with different outcomes. Ultimately, data that you can actually have intervention to. What was during your, tenure there at the NIH, did you notice was a transition of the focus of the NIH or NCI, or was it pretty much the same from the time you went in the time you left? 00:25:31:11 - 00:25:53:02 Dr. Brawley Yeah. Well, several of us and Harold Freeman, who was on the National Cancer Advisory Board and the President's Cancer Panel, who I ended up working with and publishing some papers with as well, several of us were very concerned that this was a poverty issue, that Sam Broder was right. It wasn't a race issue. It was a poverty issue. 00:25:53:04 - 00:26:25:15 Dr. Brawley It's a race issue because race frequently is the reason why people are impoverished. But, unfortunately, in 1993, there was the NIH Revitalization Act, which started mandating minority inclusion in clinical trials, and actually legislates that the reason if you read the actual law, the presumption is that the disparities are because the drugs work in whites, but they don't work in blacks because they haven't been tested in blacks. 00:26:25:17 - 00:26:51:03 Dr. Brawley And many of us have been upset about this ever since it was passed and signed into law by Clinton in 1993. Because, it ignores the fact that a large, large part of the disparities are because blacks don't get the treatment. And I've been outspoken in saying, if you don't get the drug, of course the drug doesn't work. 00:26:51:05 - 00:27:20:09 Dr. Brawley And we've been trying to remove some of this racism, from from cancer medicine, cancer science or actually medicine in general, you know, there’s so...we went through, vital and the, blood pressure medicine that was for black people and not for white people. We've gone through a number of these things, you know, and in breast cancer. 00:27:20:11 - 00:28:00:14 Dr. Brawley Yeah, I there's a period of time from about 2015 to 2020 where black women in Massachusetts had a lower breast cancer death rate than white women in 12 states. But you got a whole bunch of people out there talking about black breast cancer. We must do research in black breast cancer, by the way, group that my group published in 2006, 2007, that if you look at black women in Atlanta in the years 2000 to 2002, 7% of them who were diagnosed with an early stage breast cancer got no treatment in the first year after diagnosis. 00:28:00:16 - 00:28:01:09 Dr. Winn Wow. 00:28:01:10 - 00:28:36:07 Dr. Brawley No, not not bad treatment. That's another issue we need to deal with. No treatment. While we've got Congress out there causing the NIH and causing a series of programs to look at, you know, molecular breast molecular differences in black people with breast cancer versus white people with breast cancer. I'm more concerned the 7%, black women in Atlanta with localized chewable breast cancer are not pardon men for the change in the English language. 00:28:36:08 - 00:28:39:18 Dr. Brawley They ain't getting it cut off. 00:28:39:20 - 00:29:04:03 Dr. Winn Right, right. You know, actually, you know, this brings up a really good point that we, you and I were once on a panel together, and I remember you saying something, and I may be misquoting, but I think I remember you saying something to the extent that if we just did the freakin standard of care, right, that there would be more people saved. 00:29:04:03 - 00:29:08:24 Dr. Winn Yeah, forget about new drugs, that if we just did, is that near the quote? 00:29:08:24 - 00:29:21:20 Dr. Brawley Yeah. You know, one of the wonderful people that I've come to know and work with is, Ahmedin Jemal at the American Cancer Society. Ahmedin Jemal. 00:29:21:21 - 00:29:26:24 Dr. Winn I'm going to talk about your time for the ACS. We're going to figure out, yeah, how you get into the ACS. 00:29:27:01 - 00:29:49:02 Dr. Brawley Ahmedin by the way, worked with me when I was at the NCI, and we came back together again at the ACS. And so we started trying to figure out how can we calculate or quantify the disparity in the United States for cancer. 00:29:49:04 - 00:30:24:22 Dr. Brawley And we looked at a number of different ways. One is, you know, the death rate in, 2015 or so and from cancer in Utah was 125 per 100,000. The death rate in, Kentucky was 190 per 100,000. Yeah. The there was the real numbers, by the way. Now, one can actually have an interesting discussion about is it, good living in Utah that causes it to be so low or good living in Kentucky that causes it to be so high? 00:30:24:24 - 00:30:26:01 Dr. Winn Okay. 00:30:26:03 - 00:31:11:05 Dr. Brawley But, you could say what? How many people would not die if everybody had the Utah death rate? Well, Utah is very white and a lot of, you know, and so let's let's look at other things. Well, what we settled on was education. It turns out that the death rate of a college educated woman in the United States from cancer is 60 deaths per 100,000 per year, the death rate of a woman who is a high school graduate and progressed no further or never graduate from high school, is 120 per 100,000. 00:31:11:06 - 00:31:43:16 Dr. Brawley Double. Exactly double at my age, that's important. I can remember those two numbers because it's exactly double. Okay. By the way, women who get to college and never graduate have most of the benefits that college graduates enjoy. All right. And so what we did, and for men, it's, it's almost a factor of three. 00:31:43:18 - 00:32:15:00 Dr. Brawley High school educated men are three times more likely to die versus college. And when you look at this race drops out. Better to be a college educated black guy than a high school educated white guy. Right. Okay. Yeah. Education is really, really important for cancer death prevention. And and by the way, that college thing tells us it's a it's heavily driven by pediatrics. 00:32:15:02 - 00:32:24:03 Dr. Brawley It's not that you got to college, it's that you lived your first 18 years on a trajectory to get you to college. 00:32:24:05 - 00:32:47:20 Dr. Winn That is a very important a nuanced point, but an incredibly important point that I have not yet discussed much that we always talk about the endpoint. Once you've gotten a degree. But what you're describing is that all of those activities, again, this whole thing about how a team going back to your life story of a team of people within a community, teams around you, allows you to have that trajectory. 00:32:47:22 - 00:33:11:15 Dr. Brawley Yeah. The people who get to college and drop out are less likely to smoke compared to the people who never go to college. They are less likely to be obese when you're 40, 50, and 60 compared to the people who never got to college. There's even drinking differences. And I just hit the, the the three bit, the number three, one, two and three cause of cancer right there. 00:33:11:15 - 00:33:39:06 Dr. Brawley You know, there are differences for because of your childhood. Now, so what Ahmedin did was he pub we published a paper. And basically how many 600,000 people died from cancer every year in the United States. How many would die if everybody had the risk of death? The death rate of the one third of Americans who are college graduate? 00:33:39:08 - 00:34:03:09 Dr. Brawley The answer is, of the 600,000 deaths, 132,000 would go away if everybody had the risk of death of a college graduate. That's not a new drug. That's not a new screening test, that's just give everybody what college graduates get. 00:34:03:11 - 00:34:04:09 Dr. Winn Wow. 00:34:04:11 - 00:34:15:15 Dr. Brawley Okay, 132,000. And by the way, of the 132,000, about 80,000 are white. 00:34:15:17 - 00:34:21:13 Dr. Winn Yeah. What's amazing about that? That's about a a little bit over a 20% reduction death across... 00:34:21:13 - 00:34:23:16 Dr. Brawley 22% reduction. 00:34:23:18 - 00:34:26:14 Dr. Brawley 22% reduction. That's right, that's right. 00:34:26:20 - 00:34:46:14 Dr. Winn So you know, so I've been thinking about the progress that we've made since 1971. And the reality is we have certainly made progress. You know, I was quoting some of the numbers and Doug Lowy and others, we've been talking about some of the numbers that that show that we're making certainly some progress. And that's been a good thing. 00:34:46:15 - 00:35:01:04 Dr. Winn But your take from when you started as a a resident, a fellow till now, what has been the thing that you've been most amazed about in the context of the oncology of scientists who are in oncology field that is just the field? 00:35:01:06 - 00:35:37:14 Dr. Brawley Well, we've had a 34% decrease in death rate since 1991. It's due to prevention, especially smoking cessation. It's also due to appropriate effective screening, appropriate effective diagnostics and appropriate effective treatment. We have lost lives because we have wasted resources with inappropriate or ineffective screening, diagnosis and treatment. And so that's one of the reasons why I'm always trying to get back to evidence base. 00:35:37:14 - 00:36:11:20 Dr. Brawley Let's do it and do it right. We have lost people because there's a substantial number of people white, black and otherwise (we usually call them poor), who get what the American cancer Society lawyers begged me to call less than optimal care. That's a euphemism. All right. And, so trying to realize how good we actually could be if our system were truly efficient is what Otis is all about. 00:36:11:22 - 00:36:57:08 Dr. Winn And listen, and we appreciate that. You know, with the couple we're wrapping up this interview, I do have a last two questions. One is in your org, in your time, who particularly given the month is African-American history Month, were there any influence within your family, within your schools with other doctors, luminaries within this field, who actually impacted you and your life in the context of you mentioned a number of people, but if you had to pick the one person that was actually most impactful in your life or most impactful in the field of oncology, and including African-Americans, who would that be? 00:36:57:12 - 00:37:35:06 Dr. Brawley Yeah. Well, I, I it's hard for me to separate two people. One is Barry Kramer. And, yeah. And actually, you know, thinking back not to get inappropriate, but Jews and blacks have helped each other a lot over the years in civil rights and other things. Barry is Jewish. I'm black. And, I wish we saw more of the acknowledgment of that assistance and, wish we saw it go both ways more nowadays. 00:37:35:12 - 00:38:05:04 Dr. Brawley Yes, sir. And then the other would be David Satcher. David said, you know, I got to work, with David Satcher for almost three years. I was at the National Cancer Institute, but I was tasked by Rick Klausner, who was then the NCI director, to be responsible for health disparities research. And and Doctor Satcher started relying on me to do a lot more than just oncology. 00:38:05:06 - 00:38:23:06 Dr. Brawley But I learned how to be a gentle man, but firm, and how not to take what he would never call it. Bullshit. But I learned how not to take bullshit. 00:38:23:08 - 00:38:34:14 Dr. Winn Yes, which is an important skill in life. Last question what brings you the most hope in the field of oncology or in the field of medicine? 00:38:34:16 - 00:38:59:21 Dr. Brawley There are a bunch of young folks coming up in oncology today who all of us, you know, fought for for 30 years. There were a whole bunch of people who just didn't understand me. All right. When I talk to the fellows, I talk to the young attendings today. They understand what I'm talking about. 00:38:59:23 - 00:39:01:15 Dr. Winn That’s awesome. 00:39:01:17 - 00:39:29:11 Dr. Brawley The importance of prevention, the importance of risk reduction. I learned that one, by the way, from from a patient. You can learn from your patients is we should be talking about risk reduction more so than calling it prevention. The importance of evidence based medicine. And then, of course, something happened in the last few years that has really given me a great deal of hope. 00:39:29:13 - 00:39:47:12 Dr. Brawley And, one of my mentors, again, one who I will not mention, he's a little older than me, said, you know, Otis, the drugs are actually starting to work. 00:39:47:14 - 00:39:49:02 Dr. Winn That is awesome. Yeah. 00:39:49:06 - 00:40:29:22 Dr. Brawley You know, when actually he said this about the time that we wrote the paper, noting that there was a decline in lung cancer deaths. It's about 2013, 2014. There's a decline in lung cancer deaths in the United States that started, that started a long, long time ago. But the the slope actually deepened around 2013, 2014. And, you know, the the decline was us nice and slow from like 1990 onward because of smoking cessation that happened starting in the 1960s and 70s. 00:40:29:24 - 00:41:00:08 Dr. Brawley But the increased decline in the slope at 2013 is the introduction of immunotherapy and some of the targeted therapies in lung cancer. You know, when I, so there's two important things about my career. When I started my career, we called it minority health and later special populations. As I'm ending my career, I'm telling you that the largest group of people who are screwed by our ineffective system are actually the majority. 00:41:00:08 - 00:41:41:12 Dr. Brawley They're white people. And when I started my career in the 1980s, you know, when we were giving cis platinum, and itopside for metastatic lung cancer and the median survival was, you know, we're publishing papers. We pushed the median survival from ten months to 12 months. All of a sudden, as I end my career, we've got some immunotherapies, we've got the ALK inhibitors, we've got a number of targeted therapies, and you've got people who have been alive with metastatic disease now for ten years. 00:41:41:14 - 00:42:08:09 Dr. Brawley All right. So those those are so the young people who started to understand the fact we have drugs that actually work and help people to have good, high quality lives, and the fact that we're now starting to focus a little bit more on, on some of the right things, on how you get people good prevention, how you get people good appropriate screening, how you get rid of the waste. 00:42:08:15 - 00:42:11:16 Dr. Brawley Those are the three things that make me happy. 00:42:11:18 - 00:42:41:04 Dr. Winn You know what Dr. Brawley, thank you for ending on that note. As I am going to continue to say, I, this has been really, a highlight for me, personally. Yeah. What I will say and, you know, this, and I've said this to you privately and I'll say it publicly, you've been one of the major impact players for a number of us, throughout the years, who inspired to make sure that excellence is excellence no matter what and at all times. 00:42:41:06 - 00:42:42:05 Dr. Winn Thank you so much. 00:42:42:05 - 00:43:00:12 Dr. Brawley So thank you for that. And, I want to just say, that, it has been the most wonderful experience of you taking some time out and reflecting back on what you've done and the impact you've made. And I just want to let you know that, if you had any doubt, you should doubt no more. 00:43:00:14 - 00:43:04:12 Dr. Winn Your impact has been felt by many people. And so thank you. 00:43:04:14 - 00:43:05:14 Dr. Brawley Well, you're,