Dr. Selwyn Vickers

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0:34One of everyone's greatest fears is that he or she might be diagnosed at some point in their life with cancer. I recently had a chance to talk to Dr. Selwyn Vickers, who runs Memorial Sloan Kettering Cancer Center, one of the leading cancer centers in the United States, and I had a chance to talk with him about the progress being made in treating cancer. So today, we are about, I guess, more than 50 years after President Nixon declared war on cancer. Have we really made that much progress in the 50 years or so since he first declared war on cancer? Yeah, I think we have. The ability for someone who has a diagnosis of cancer broadly, thinking about having a chance for cure, has significantly improved.

1:16We've gone from all cancer diagnosis probably around the time of that announcement that was around 30 to 40 percent chance of cure. that we're approaching 68 % to 70 % of patients across the board who get a diagnosis of cancer have a chance at five years to being told they don't have a tumor. So what is the best way to avoid getting cancer? I guess that's a question everybody asks, but what is the answer to that? Yeah, I think the best way to avoid it is obviously healthy lifestyles, avoid smoking, certainly limit red meat to the amount that you eat. Now, all of these statements are no guarantee you won't get cancer, but we do know to some degree that they probably have a role in accelerating or increasing risk.

2:00In general, there is no actual way to prevent it. There are certainly things we do can screen early, and if we catch cancers early, we have a really good chance of curing them. What extent is environmental factors, what extent is it behavioral factors, and what extent is it genetic factors that causes cancer? Yeah, so it's a combination. There's a small percentage of inherited genes that put you at risk. The most common is BRCA1 and 2 for women with breast cancer, increasing risk of ovarian cancer as well, and one or two others. Those we know and we can detect. There are certain other select genes that are passed on that significantly increase your risk, but that's a small number.

2:41The other genetic aspect are genetic mutations that occur over time because of the environment and age. Those somatic mutations, sometimes caused by viruses, caused by cells that are not correcting themselves, certainly have a role in actually producing malignant cells that grow on control. And then I think there are certainly environmental exposures. And we are learning more. We know that there are classically ones from multiple chemicals that do it. But it's the broad combination. But I would say the biggest contributor is our aging that has a big factor in it. So what is the most common cancer that humans get?

3:19Is it lung cancer, breast cancer, pancreatic cancer, brain cancer? What is the most common? So the most common cancers in America are breast and prostate. 300 ,000 cases of breast, somewhere around 280 ,000 cases of prostate. Lung is arguably one of the most, if not the number one killer. It's about 150 ,000 cases, but it is the most lethal large number. Pancreas cancer, the incidence has increased. When I began my practice, there was about 30 ,000 cases a year. On average now, there are over 65 ,000 new cases of pancreatic cancer a year. And so it's approaching a level where it's going to be the second killer, most common killer of patients with cancer, even though it doesn't have the numbers like breast cancer.

4:12We can cure well over 90 % of breast cancers, and well over 95 % of prostate cancers are cured. And now with respect to prostate cancer, there's a PSA, which is a kind of a blood marker. Yeah. But we don't have those kind of things for brain cancer or for pancreatic cancer, right? We don't have a marker. We don't. We don't. We are, they are clearly tests that are being evolved based on being able to detect circulating tumor DNA and other markers and our ability to have broader ability to manage the data through computational oncology that are giving us gradual insight for early detection. It's not as specific as we want, and it's not completely as accurate.

4:55So sometimes if I get a positive test, I really don't know which tumor to look for. Sometimes it does give directions, but that's evolving. But you're right, we have PSA, we have mammograms, we have colonoscopy, we have cervical screening for certain cancers, and we have CT scans for lung. But we don't have broad availability of screening for the large number of cancers that are still killers Now the type of cancers that are killers are ones where you don't know about them until maybe stage four Glioblastoma brain cancer is that type pancreatic cancer is another type maybe liver cancer. That's right How do you know if you have one of those kind of cancers?

5:33What is the best way to go in for an annual cancer checkup or what do you do? Yeah, so? So it's hard, and that's a question that's perplexed me. I would love to say go out and get a CAT scan for everybody. We can't do that. We don't have enough CAT scanners to screen. We need a better ability to enrich who's truly at risk. And recent studies now with AI have been able to begin to predict who in the population by virtue of a number of things that they've pulled together, their medical history, some blood tests, who's at risk for a pancreatic cancer. We do know now if you're a smoker and if you're a certain age or exposed to smoke, you should, in the over 50, you clearly should get a low-dose CT scan, which has proven to have a significant difference in outcome and detect early cancers.

6:22And yet only about 6 % to 8 % of the eligible candidates take advantage of that CAT scan. So one, I think it's coming, David, that AI programs looking at our broad array of data can enrich the population who we know may be at risk. And then once doing that, probably getting a scan, MRI, a CT scan is going to be the tool, which we can't do for everybody, but we can do for a select population. Now, pancreatic cancer, that's a disease that Ruth Bader Ginsburg died from, and increasingly many people have it. You don't typically know you have it until stage four. You are a pancreatic cancer surgeon, right?

7:00Why did you decide to specialize in that area? You know one a couple of things number one at the time that I trained at Johns Hopkins We were the leading center for treating patients with pancreatic cancer and as you talked about at that time the Leading opportunity to make a difference in somebody's life was surgery So number one, I felt I had great training and had capacity to make a difference by virtue of that skill set. So it was the environment, the leaders there who encouraged us to look at difficult problems and make a difference. So one, it was a skill set of training. Two, I was at a center where we focused on it.

7:42And three, it was a problem that really needed the attention to make a difference. I soon learned as a surgeon after I did my first hundred patients for pancreatic cancer successfully Operating on them I could count on one hand how many were alive at five years And so I knew it was a bigger problem than just my surgical skills could resolve Okay, so I'm always worried about pancreatic cancer, too. Yes. What's the best sign that I might be having pancreatic cancer? You know there are the signs of cancer are often due to something simple But if you were to think about the things that you might worry about, particularly as you get older, we don't naturally just lose weight when we get older.

8:25So one, if there's a sudden weight loss. So you want to ask the question, why am I dropping weight, even though I've been trying for the last five years and nothing's happened? New onset diabetes that for some reason now I don't have a history of it. I'm over 65 and I'm developing diabetes. And then subtly, although not early on, it's the case where either somehow my urine turns dark or I begin to have some shades of change in my eyes or my thumbnails that begin to look a bit of a yellow, what we call jaundice. Now, you said weight loss is a sign sometimes that something isn't good. But I know it's not directly in your area, but Ozempic, which is now a very popular drug to reduce weight.

9:13Some people say that it might cause some type of tumors. Are you an advocate of Ozempic for everybody or for some people? Yeah, I think as the new GLP-1 inhibitors, which are these drugs that really affect how we feel about being full, become further advanced, I think it's going to be an overall sea change for American health care, including cancer. because we know obesity over time has a significant impact increasing cancer rate and risk. I don't have a strong opinion about at this stage whether an Ozimbik or a Manjuro would cause a cancer, but I think the global impact is one to actually reduce our overall health burden, including cancer.

9:58Join Bloomberg in Houston or via live stream on November 4th for the future investor, Finding the Opportunities. This 2025 event series will examine how companies are investing in their businesses to create efficiencies, innovating their products and services, and improving the customer experience. This series is presented by Invesco QQQ. Register at BloombergLive.com slash FutureInvestorHouston. That's BloombergLive.com slash FutureInvestorHouston. Let's talk about your background. Where were you born? So I was born in Demopolis, Alabama. It's in a small town in the Black Belt of Alabama, a rural farming area where my parents were educators.

10:41Now, your parents were extremely well-educated for blacks in the South at that time. How did they get so well-educated? Yeah, so on my father's side, it was really parents who themselves had limited education. My grandfather, with a fourth-grade education, who didn't learn how to write and read until he was in his 40s, who really felt his children needed a college education. And on my mother's side, her mother in the 1920s had to travel 200 miles to an academy that started by Presbyterians in the southern part of Alabama to get her high school degree and then went 10 summers to get her bachelor's degree.

11:22So they had foundations of understanding the value of education and the ability, particularly for a Negro in the South, to have a chance to advance their lives and careers. You grew up in a segregated environment, I assume. So you were the only child of your parents? Yes. So did they say, we're putting all our hope in you and we want you to be a pancreatic cancer surgeon? No, they had no clue what I might be. I think they simply wanted me to do the best I could in anything I took my interest in. And clearly achievement in high school and undergrad was really sort of the first thing that they looked for and expected of me.

12:03And I tried to do that because I realized the legacy of both grandparents and even great grandparents who studied with Booker T. Washington, that I had a significant responsibility. So were you a superstar in high school? You know, I was a good student. I would say this. I grew up in a town called Huntsville. It really offered the best education that I could get in Alabama at the time. But when I arrived at Johns Hopkins, I was probably behind 95 % of my classmates in what I'd been exposed to. But you must have done okay at Johns Hopkins undergrad because you got into Johns Hopkins Medical School.

12:40Yeah, I had to catch up. It took me about a year to catch up. And, you know, there were classes my classmates had who went to prep schools I was taking for the first time. I hadn't had calculus when I arrived and they'd all had calculus and so the level leveling of the playing ground Took me about a year for that to occur once the playing ground became level I found that I compete at just as well as they could when you went to Johns Hopkins Medical School Which is one of the most famous medical schools in the country or not in the world Was it very integrated at the time were mostly white? So there was a there was a surgeon there who was from Alabama a guy named Levi Watkins who became a mentor and friend and And he grew up in Alabama where my grandmother and my mother went to the college where his father was president.

13:28Levi went to Tennessee State, Vanderbilt, and then Johns Hopkins. Stayed on faculty, but challenged Johns Hopkins that it clearly needed to be more diverse. So he wrote all the African-American medical applicants in the country and encouraged them to apply to Johns Hopkins. And he provided a platform for people like me to have an interest in going there. So after you graduated, what did you do? So after I graduated, I made the transition to realize I wanted to be a surgeon, looked around the country and decided to stay in Baltimore because I thought Hopkins had the best surgical training of that time.

14:03But ultimately, you went back to Alabama. That was a hard decision. I had an offer to stay on faculty at Hopkins. I'd been there in Baltimore for 16 years and briefly accepted a job to stay, but then changed my mind to go to Alabama, in part because I felt I wanted to go back home into a new environment. Now, as a great surgeon, sometimes you might say, I don't need to go be into administrative parts of hospitals. I just want to be a doctor, just do surgery. What prompted you to want to get out of just doing surgery to be an administrator and a hospital leader? Yeah, I think it was, again, watching others who did it well.

14:44I had a dean who recruited me from Birmingham, Alabama to Minneapolis, Minnesota, which is a big jump to convince me to move my family. But she did several things that showed me the power of a leader at a significant level to affect the career of other leaders. and after I'd helped build a growing department of surgery at the University of Minnesota I thought I could serve in that role. In particular I realized over time that my training as a surgeon brought a set of credible things to the table. One if surgeons have a measure of emotional intelligence not much of our training reinforces that it reinforces skill not necessarily emotional intelligence, but if a surgeon has some self-awareness and emotional intelligence, what they bring to the table of leadership are three fundamental things.

15:37Number one, they do everything in teams. Their operations, their patients they see is all team focused. Number two, they value process, but they hold themselves very much accountable to execution. They understand that it's good to explore a patient, but what really matters is did you take the tumor out? And then number three, they make difficult decisions on incomplete information. Those things I realized that I could bring to the table as a leader if I had a sort of a passion for working with people and had some sense of self-awareness. So you rose up in Minnesota. Why did you go back to Alabama, which had racial issues?

16:18UAB is a unique place. It's a bit of an oasis of academic excellence, broad diversity. It's the most diverse Carnegie Tier 1 research university in the country. It's done more transplants in African-American than any hospital in the world. So I felt a compelling opportunity to continually drive the mission of that institution, in spite of the landscape socially and politically, that I thought it could have a significant impact on that part of the world. And how long did you run UAB? So I was there for nine and a half years. almost 10 years. So when Memorial Sloan Kettering approached you, did you say, look, I'm a great surgeon.

16:59I got what I want right here. I don't, this is my native state. I don't need to leave. Were you intrigued? No, it was more, more of the former, like you said. It was, I have a good place, have a good job. I've built a level of trust in the community. I have a compelling mission. and I think I need to really think very hard about leaving it. And I would say there are very few places that would intrigue you to consider it, leaving, and Memorial Sloan Kettering is one of them. So as you rose from a small town, only child in Alabama, to where you are now, you must have encountered a fair amount of racial prejudice.

17:38Yeah, I had my share of it. I learned early on from one of my mentors at Johns Hopkins. He was one of the faculty there, and he reminded me that people will often have difficulties with you, but don't make their problem your problem. And so one of my early experiences of taking care of a patient who had a liver cancer, or in this case, a bile duct cancer, they struggled that there was a black surgeon saying that they needed half of their liver out. I respected that because it was unusual. Even my grandmother had not ever seen a black doctor. So that was a foreign thing to her. So I respected the understanding that what they were going through was not the norm.

18:30They called back to Johns Hopkins to see if I actually trained. And I said, do what you need to do to be comfortable with this situation. So when you join Memorial Sloan Kettering, what you want to do is expand the coverage of Memorial Sloan Kettering and make sure more people were able to get the services. What progress have you made so far in that? I have wanted Memorial Sloan Kettering to be a cancer center to the world, both culturally, ethnically and geographically. And there have been great efforts that have occurred, some of them before I got here. One of the efforts by our legislative team was to get our state to really drive, manage Medicaid, manage care in New York to actually negotiate with Morris Sloan Kettering so patients with Medicaid broadly could access us.

19:14We've had that law enacted and patients now broadly are able to come to us. Our Medicaid service of patients is up by 63 percent. So, number one, we now are getting a broader access of patients. Number two, we're partnering with hospitals across New York City. Jamaica, Queens Hospital near JFK, which has a tremendously diverse population. The most diverse county in America is Queens. We're partnering with them to develop a cancer program. We also work with New York Hospital Health and Services also for clinical trials and patients access at our Ralph Lauren Cancer Center. And we've developed a broad strategy around health equity that I think will further impact our city and our region for making sure everyone has access to the best cancer care in the world.

20:00So as the head of Memorial Sloan Kettering Cancer Center, your biggest problem is getting enough money to do the research and give the patients the care they want. So you're always raising money or that's not your biggest problem? You know, it's not my biggest problem, but it is a problem. There is no doubt the cost in health care is significant, not only for our patients, but for the science and for the drugs. So it is a significant part of what I do is putting resources on the table so that our scientists, our clinical trialists, and our physicians are able to do their job and make discoveries.

20:32So Memorial Sloan Kettering, what it does is it does research and then also does patient care. Yes. And there's an advantage, you would say, to patient care because you have people doing the cutting-edge research? Yes. Cutting-edge research that's connected to doctors who are looking to answer questions as well as take care of people. You also have students at Memorial Sloan Kettering. You have a graduate school for students. Is that right? Yeah. So the Gerstner School is really one of the outstanding biomedical graduate programs in the country. That our students are focused in our labs largely on basic science and cancer research.

21:07We also have almost 2 ,000 fellows and residents who rotate the Memorial Hospital. So we have a robust educational program, although we don't have a distinct medical school, great graduate school, great training programs, nearly 100 different fellowships at Memorial. Suppose somebody says they have a cancer that's, let's say, not a very good kind of cancer, not that any cancer is good, but suppose you have something that's very serious stage four, glioblastoma. The advantage of coming here is you can really make a difference at stage four for somebody? Yeah, so the advantage of coming here broadly, so number one, the outcomes are different even at stage one for coming to a memorial.

21:49At a stage four, we certainly have the better chance of often prolonging life and having a chance to getting access to the most novel therapeutics. with no guarantee that we're going to cure you, but we're going to give you every chance there is in the space of cancer to make a difference in your tumor. So how does somebody become a patient? Somebody walks off the street and says, I think I don't feel well, maybe I've got a cancer. How do people get to be a patient here? So, number one, you can refer yourself and call, and we will help make that diagnosis. Or number two, your physician who you've seen as a primary care doctor can refer you here, either way.

22:28Suppose somebody says, I don't have any health insurance. What do you do? We have services to take care of people who don't have financial ability. So when you were doing pancreatic cancer surgery, you're not doing surgery now, are you? I still do some surgery. You're still surgery. Yeah, they let me come in the operating room by permission. Special occasion. But if you're only doing it occasionally, can you still do surgery and really be up to speed on everything? Yeah, so I do it regular enough to know that what I do, that the outcomes are not affected. So I have to, as a low-volume surgeon, you have to watch closely.

22:59And I typically operate with my other surgeons so that I have other senior surgeons who are part of the picture as well. What does it take to be a great surgeon? This may sound trite. Perseverance. Resilience. In practical terms, being able to take a blow and not having it become a permanent deformity. And grit. The ability to really turn lemons into lemonade. and to not both let discouragement or disappointment from the prior patient prevent you from taking care of the next patient you see. You're relatively young by my standards, so this is something you expect to do for another decade or so, something like that?

23:40Yeah, I would say that would be the goal. There are some things that I want to see accomplished at Memorial. It's a place of phenomenal people and talent. More than ever, as we talked about people getting older and the incidence of cancer really growing. I think we have a special role for the society, not only in New York and America and the world, then the role that we play around discoveries and what I think is a golden age of cancer treatment. Did your parents live to see your success? You're obviously an extremely successful person. Did your parents live to see this? You know, my mother did to a degree.

24:13She saw a large part of success as it relates to both my family. She lived to see my four kids born, which was immense since I was an only child. I think she certainly desired a larger family. And she saw some of my success as an academic surgeon, particularly for people in her purview who I treated and operated on. I just saw a man two or three weeks ago with my father who I did a pancreatic cancer procedure on 22 years ago, who's still alive. So my father has seen that as well. And clearly, who's 92, has seen much of my success throughout my journey as an academic surgeon and leader. Thanks for listening.

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