Oncology, Etc. - In Conversation with Dr. Otis Brawley (Part 1)

In this two-part episode of Oncology, Etc., hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) speak with Dr. Otis Brawley, a Bloomberg Distinguished Professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society, about his incredible life and career. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 9/7/2021   TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. No mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. PAT LOEHER: Hi. I'm Pat Loeher. I'm director of the Centers of Global Oncology and Health Equity at Indiana University Melbourne and Bren Simon Cancer Center. DAVID JOHNSON: And good morning. I'm Dave Johnson. I'm professor of Internal Medicine Oncology at the University of Texas Southwestern in Dallas. We're really excited to be back with the second episode of our ASCO Educational Podcast Oncology, et cetera. And I don't know about you, but my arm's really sore from entering all the fan mail we got from the first episode. Either that or maybe it was that shingles shot I got last week I don't know. PAT LOEHER: No, I agree. I really appreciate Bev. Your wife just kept texting me how wonderful I was, and it was-- I enjoyed it. DAVID JOHNSON: Well, I'm glad you mentioned that, because I wanted to read this one fan mail. It says, dear, Dave. Thanks for carrying Pat [INAUDIBLE]. I don't know who that is, but I appreciate it. PAT LOEHER: Yeah, it works both ways. Works both ways. So what have you been reading lately, Dave? DAVID JOHNSON: Well, as you know, I love to read. And actually what I'm reading right now is The Howe dynasty by Julie Flavell. It's about the brothers Howe that were involved in the Revolutionary War. But the book I finished just prior to the one I'm reading now is Adam Grant's Think Again, which I really enjoyed. It made me think again. What about you? PAT LOEHER: How many times have you read the book by the way? DAVID JOHNSON: Again. Twice. PAT LOEHER: Think again. Yeah. There was the book that's called The One Thing. I know if you saw that book which I read a while back. It took me, like, a year to do it, because I just kept doing other things while I was reading it. I felt so guilty about it. I did read the book Caste recently, and it was on Oprah Winfrey's list. Barack Obama picked it. And actually read that on my way to Kenya a couple of months ago and found it very fascinating actually. You know, the notion of the juxtaposing of Nazi Germany, of the caste system in India, and the racial struggles that was going on here in this country. And I thought it was a very well written book. DAVID JOHNSON: Yeah. You mentioned that book to me, and I finished reading it a couple of weeks ago. I agree with you. I enjoy it very much. I learned a lot. We want to introduce today's guest. We're really, really fortunate to have with us today Dr. Otis Brawley. Dr. Brawley Is the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University. He's a graduate of the University of Chicago School of Medicine. He completed a residency in Internal Medicine at the University Hospitals in Cleveland Case Western Reserve and did a Fellowship in Medical Oncology at the National Cancer Institute, where he spent a good portion of his early career. In the 2000s, he relocated to Atlanta, where he became medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital. One of the really most famous safety net hospitals in America. He was deputy director of Cancer Control at the Winship Cancer Institute of Emory University. And then he moved on to really a significant role. He became the chief medical and scientific officer and executive vise president of the American Cancer Society from 2007 to 2018, and we'll have a chance to perhaps query him about that. Currently, he leads a broad interdisciplinary research program on cancer health disparities at the Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center. Dr. Brawley has received innumerable awards. It would take the whole podcast to list them all. But among them are the American Medical Association Distinguished Service Award, University of Chicago Alumni of Professional Achievement Award, and-- one that I think is particularly poignant for ASCO members-- the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control. In 2015, Dr. Brawley was elected to the National Academy of Medicine and well deserved. So just welcome to oncology, et cetera. Thank you so much for taking the time to be with us today. OTIS BRAWLEY: Thank you for having me. It's a pleasure to be with you and Pat. DAVID JOHNSON: Well, it's great to have you. I can tell you that. So let's just start with just a little background. Why don't you tell us about yourself? Where are you from? Where did you grow up? OTIS BRAWLEY: I grew up in Detroit. I grew up in one of the automobile worker neighborhoods, a blue collar neighborhood, and went to the Catholic schools there. The nuns in grade school pushed me toward the Jesuit school for high school, and the Jesuits in high school taught me how to think and really propelled me. And indeed much of my career, much of my writings, my philosophy toward medicine was really influenced by early education with the Jesuits. DAVID JOHNSON: Wow. PAT LOEHER: Hey, Otis. I just want to throw in-- in terms of books that we've read, one of the other books that I want to give a shout out is the book you wrote called How We Do Harm, which was really a wonderful book. I think it was several years in the making. Would love to hear how you made that. But I do-- while you're talking about your background, speak a little bit about Edward McKnight Brawley and Benjamin. OTIS BRAWLEY: Oh, OK. Benjamin Brawley was my grandfather's brother, and Edward McKnight Brawley was my grandfather's father. They're both ministers in the Methodist Church, the AME Church. Benjamin Brawley was dean of Morehouse College back in the 1920s, and he was the first Brawley to graduate from the University of Chicago. He got a PhD from the University of Chicago back during the 19-teens. And those are just a couple of my relatives. If you go to Morehouse, you'll find that the English building is Benjamin Brawley Hall, and Edward McKnight Brawley was his father and was a free Black back before the Civil War, and a minister before, during, and after. PAT LOEHER: Incredible legacy. Incredible legacy. DAVID JOHNSON: Those were your relatives from the South from the Georgia area? OTIS BRAWLEY: Well, my father grew up in Northwestern Alabama. An area called Leighton, Alabama. It's near Muscle Shoals. So those of us who remember the Beverly Hillbillies. My mother is from the middle of Arkansas. She's from Pine Bluff, Arkansas. And they met in Detroit. They were part of that northern migration in the early 20th century, where a large number of Blacks left the rural South and went up North to get jobs primarily in the industrial North. My father arrived there right after World War II. He served in World War II, got discharged, and went to Detroit. My mother actually went to Detroit really early on during World War II and worked in an airplane factory during the war. Then the two of them met. My father was a janitor at the Veterans Hospital in Detroit, and my mother worked in the cafeteria there. And that's how they met. They had my older sister, who was 8 years older than me, who became an attorney. And my younger sister was a certified public accountant. PAT LOEHER: What a remarkable story for your parents. And tell us a little bit about your journey to become a physician. How did that happen? OTIS BRAWLEY: It was very interesting. In high school, I was very talkative. I was very interested in policy. I did debate. It was very not a sciencey kind of person. In college, I became very interested in Chemistry and for much of College. I was going to go to graduate school in Chemistry. And luckily, when I was in college, I came under the influence of an infectious disease doc named Elliot Kieff. And he and I became very good friends. He was chief of infectious disease at the University of Chicago at that time. And over about two years, Elliott convinced me to drop the Chemistry thing and go to Medical school. And I applied to Medical school late, because I was so late in making that decision. I got into the University of Chicago and stayed there because my support system was there. And then in Medical school came across another gentleman. I've been very fortunate to have good mentorship and good people. They influenced me over the years. John Altman, who was one of the original medical oncologists back in the 1950s when there was arguments about how we should be staging people. Should there be four stages or three stages, and that sort of thing is when John really cut his teeth in Oncology. He became a great lymphoma doc. John took me under his wing while I was in Medical school, and pretty much open the world up to me, and explained to me how the world rotates in Medicine. And that heavily influenced me. Told me to go into Oncology because I still had an interest in Policy. And he said there's going to be a lot of policy in oncology in the future, and the best way to get involved with it is to get your credentials as a medical oncologist. And in many respects, I think in the early 1980s, John was thinking I was going to be chief medical officer of the American Cancer Society, which I obtained in 2007. PAT LOEHER: Wow. Yeah. We want to hear more about that. I just have to throw this in parenthetically that one of the things I did here is that I applied late to Medical school and got into the University of Chicago. I just wanted to know that I applied early, and there was a lesser known school in Chicago that sent me a rejection letter. And not only did they reject me, the last line of it says, good luck in whatever career you decide to go into, meaning that, if you can't get into our school, there's no way you'll be a physician. So I really admire you. DAVID JOHNSON: Yeah. I applied late too and-- PAT LOEHER: Got into Vanderbilt. DAVID JOHNSON: No. No. No, no. I didn't go to Vanderbilt. I only got into accepted to one medical school, and it was late. I was just like my career as a chief. And I was, like, the last person admitted to my class in med school. That's unbelievably interesting. Tell us, was John your influence to go to the NCI? Or what prompted you to choose the NCI for your medical oncology training? OTIS BRAWLEY: Actually, John was very influential in that decision. I told him I wanted to go into medical oncology when I was a resident in Cleveland. And he said, Otis, in his Austrian accent, I have been expecting this phone call. And he then told me where I was going to apply and gave me a list of nine places to apply. He told me I would get an interview at every one of those places. And as I was going place to place, I should rank them one, two, three, four. And so I called them with his ranking. And my first choice was not the National Cancer Institute. At which point he told me, if you go to that place, I will never speak to you again. PAT LOEHER: Oh wow. OTIS BRAWLEY: And I said, but you told me to go there to interview. He said, I wanted you to interview there, but I don't want you to train there. And I said, well, my first choice is the National Cancer Institute. And he said, fine. And a couple of days later, I got a phone call from the National Cancer Institute, and I got hired. And I will also tell you I called John up. And he says, Otis, I have been expecting this phone call. And then he said, now I want you to realize something. There is an old boys network, and your job is to get more Blacks and women into it. That's how you will thank me. PAT LOEHER: Wow. Wow. DAVID JOHNSON: So you were at the NCI at a period of time where many people would say it was the heyday of the NCI. I think it's still the heyday now, but tell us about your experiences there. What was it like? OTIS BRAWLEY: It was fascinating. It was when Vince DeVita was still the director. I was there for the transition. Eli Glatstein was the chair of Radiation Oncology. It was an amazing group of people. Dan Longo was there doing lymphoma. Marc Lippman was still there doing breast. It was just an amazing group of people when I applied, and interviewed, and when I first got there. And there was still a lot of excitement. We were still heavily involved in chemotherapy. Of course, I was up on the 12th and 13th floor building 10. Down on the second and third floor was Dr. Rosenberg doing his immunotherapy work, which of course, has now paid off dramatically. Some of the old monoclonal antibody work that led to a number of wonderful drugs was being started at that time in the mid to late 1980s. And so it was still a very, very exciting time at the National Cancer Institute. And in many respects, we were still on that burst of optimism that started with Nixon's war on cancer in 1971. It was still felt almost 20 years later at the National Cancer Institute. DAVID JOHNSON: And you linked up with an old friend of mine from the old Southeast Cancer City, a gentleman by the name of Barry Kramer? OTIS BRAWLEY: Yes. DAVID JOHNSON: What a wonderful relationship. So how influential was Barry in your involvement? OTIS BRAWLEY: Barry was incredibly influential. As I said, I have been very fortunate that along the way I have come under the influence of some amazing physicians, and I've had amazing mentorship. And that's actually, I think, important for all of us in oncology. Barry and I got to work together for quite a long while. Barry influenced me and literally taught me epidemiology. Got me some major opportunities at the National Cancer Institute and really was influential in promoting me and boosting my career. PAT LOEHER: I want to move you a little bit longer in your career and talk about the ACS and a little bit your experience there, Otis. And then with that, actually, maybe the secondary question is, a commentary on the leaders over the years that you have had-- the aspects of good things about leadership and the poor things. And obviously, you have certainly much to share on that. OTIS BRAWLEY: Yeah. Well, as I devote my career at the National Cancer Institute, I went to the Division of Cancer Prevention and Control. Under Barry, learned a lot of epidemiology, and learned a lot about screening, learned a lot about treatment outcomes, got very involved with some of the disparities or minority health issues. And then I was very fortunate to be detailed to work in the surgeon general's office and work with David Satcher when he was surgeon general. He's the one who started using the words, health disparities. Prior to that, we called it minority health or special populations. He used health disparities. And I was able to use some of my epidemiologic talents to develop some of those arguments using science to show. And actually some of the things that we had to show, believe it or not, was we had to show that equal treatment yields equal outcome amongst equal patients, because a lot of people, especially the politicians we need to deal with, were really hung up. And we still see this to this day that people are hung up that Black biology is different from white biology. Even in breast cancer today I hear that even though I like to point out there are now six states where the Black death rate for breast cancer is the same as the white death rate for breast cancer. And there are 12 states in the United States where white women have a higher risk of death from breast cancer than Black women in Massachusetts. But anyway, we got into this biology thing. And so I was very fortunate again to work for David Satcher and had some exposure to Tuskegee syphilis trial and the president's apology for that. So I was really involved with a number of things. And then the Jesuits still back there-- always think, always be contemplative, always reflect on what you're doing, always question what you're doing. Father Pawlikowski's maxims, which Dick Cheney sort of preferred is a few years later. And that is there are things you know, things you don't know, things you believe. Question what you know more so than anything else. And so that's really how I develop my concerns about orthodox use of Medicine. And using the science and applying it in a very Orthodox way, I started realizing that a lot of the disparities were due to wasted resources with people being non-scientific especially in the era of the 1990s, where everybody was doing prostate cancer screening, and there was not a single trial to show that prostate cancer screening saved lives. Yet all the resources were going into that, and people were literally-- I was able to go to various safety net hospitals and see all the resources being diverted away. People would shut down cervical cancer screening programs to do prostate cancer, which just didn't make sense. So I got very interested in how you practice medicine. Went to the Emory in 2001, because I wanted some practical experience outside of government. And had a wonderful opportunity to go there. Work at Emory. Work at one of the largest safety net hospitals in the country. Learn a little bit about the practical application of Medicine and some of the problems that people at safety net hospitals encounter. Worked with the School of Public Health and folks who did health education to learn how to convey messages. And then I was very fortunate. You know, the American Cancer Society is right down the street from Emory University. And I had met the chief medical officer of the American Cancer Society, Harmon Eyre, back in the 1990s when I was at the National Cancer Institute. And again this sort of mentoring thing comes up again. Harmon called me up one morning and said, why don't we go to lunch? And so we went to one of the student cafeterias at Emory and had lunch. And he essentially said, you know, I'm 67 years old. I've had this job for 20 years. I'm tired of it. Why don't you take it? PAT LOEHER: Wow. OTIS BRAWLEY: And so I applied to be chief medical officer of the American Cancer Society and got to know John Safran, who, at that time, was the CEO, who was a wonderful man with incredible vision. Again, this mentorship thing comes up again. PAT LOEHER: Well, Dave we had a lot of information here. We're going to carry this over. This concludes the first part of our two-part interview with Dr. Brawley. And our next episode will air on October 5. We'll talk a little bit more about Dr. Brawley's life experiences and particularly his work with the American Cancer Society NCI. He's been an incredible individual, and we look forward to finishing up this conversation. Thank you to all our listeners for tuning in to Oncology Et Cetera an ASCO Education Podcast, where we'll talk about anything and everything. If you happen to have an idea for a topic or guest you'd like to see on the show, please email us at [email protected]. Thanks again. And remember Dave has a face for podcast. 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