1 00:00:00,535 --> 00:00:02,865 - This is Laura Dedo with the Becker's Healthcare Podcast. 2 00:00:03,405 --> 00:00:06,225 I'm thrilled today to be joined by Dr. James Abraham, chair 3 00:00:06,225 --> 00:00:08,745 of hematology and medical oncology at Cleveland Clinic. 4 00:00:09,045 --> 00:00:10,265 Dr. Abraham, it's a pleasure 5 00:00:10,265 --> 00:00:11,425 to have you on the podcast today. 6 00:00:13,285 --> 00:00:15,985 - Uh, thank you, Laura. It's, uh, an honor for me 7 00:00:15,985 --> 00:00:17,425 to be part of this podcast. 8 00:00:18,845 --> 00:00:21,015 - Well, fantastic. And you know, I'm looking excited 9 00:00:21,115 --> 00:00:23,255 to our conversation because there's 10 00:00:23,255 --> 00:00:25,095 so much happening in cancer care today and, 11 00:00:25,095 --> 00:00:27,255 and really, I know Cleveland Clinic is on the forefront 12 00:00:27,255 --> 00:00:30,095 of a lot of the different innovations and, and treatments. 13 00:00:30,235 --> 00:00:32,255 So I'm looking forward to learning more 14 00:00:32,255 --> 00:00:33,495 about what you have in store. 15 00:00:33,555 --> 00:00:35,095 But before we dive into my questions, 16 00:00:35,355 --> 00:00:36,295 can you tell us a little bit more 17 00:00:36,295 --> 00:00:37,535 about yourself and your background? 18 00:00:39,325 --> 00:00:43,305 - Uh, sure. Um, so I'm the department chair, uh, 19 00:00:43,325 --> 00:00:46,585 for the hematology and oncology at, uh, Cleveland Clinic. 20 00:00:47,365 --> 00:00:49,625 Um, I'm a breast cancer doctor. 21 00:00:50,005 --> 00:00:52,825 Uh, so I've been doing breast cancer, uh, 22 00:00:52,845 --> 00:00:54,385 for the last 20 years or so. 23 00:00:54,925 --> 00:00:57,265 Um, uh, that's my patient care focus. 24 00:00:58,005 --> 00:01:01,185 Um, and then of course, um, clinical trials 25 00:01:01,185 --> 00:01:02,945 through N-S-A-B-P and N Energy 26 00:01:02,945 --> 00:01:05,665 and many different large clinical trials group. 27 00:01:06,325 --> 00:01:09,385 Uh, from an administrative perspective, for the last, um, 28 00:01:09,605 --> 00:01:13,585 uh, four or almost five years, uh, I've been running one 29 00:01:13,585 --> 00:01:17,185 of the largest, um, uh, hemo departments in the country. 30 00:01:18,005 --> 00:01:20,985 And as you know, we have presence here in Ohio. 31 00:01:21,365 --> 00:01:24,265 Uh, we have more than a hundred hematology oncology doctors 32 00:01:24,375 --> 00:01:27,745 here in Ohio, and we have, uh, presence in Florida, 33 00:01:28,405 --> 00:01:31,145 and we have presence in, uh, uh, in Abu Dhabi. 34 00:01:31,525 --> 00:01:35,865 Um, so it's a global, uh, uh, organization, um, 35 00:01:36,075 --> 00:01:37,465 delivering cancer care. 36 00:01:40,165 --> 00:01:42,565 - Absolutely. Well, fantastic. Um, you know, and, 37 00:01:42,565 --> 00:01:45,285 and I'm wondering from your vantage point leading such a 38 00:01:45,575 --> 00:01:48,805 great institution at Cleveland Clinic, um, for cancer care, 39 00:01:48,805 --> 00:01:49,965 what are some of the biggest issues 40 00:01:49,965 --> 00:01:51,485 that you're following in 2024? 41 00:01:53,835 --> 00:01:57,335 - So, um, so let me kind of say, you know, some 42 00:01:57,335 --> 00:02:00,455 of the external issues and some of the internal issues. 43 00:02:00,795 --> 00:02:03,935 Um, so external when we watch 44 00:02:04,115 --> 00:02:06,015 and see what's happening, um, 45 00:02:06,275 --> 00:02:09,175 and I'm talking about outside, purely outside 46 00:02:09,175 --> 00:02:11,335 of the four walls of the hospital, 47 00:02:11,515 --> 00:02:15,175 and we are looking at, um, um, um, uh, 48 00:02:15,355 --> 00:02:16,895 the cost of care delivery. 49 00:02:17,595 --> 00:02:20,775 Um, again, that's not unique for healthcare, 50 00:02:21,355 --> 00:02:24,615 and it's not just unique for oncology, uh, space, 51 00:02:25,195 --> 00:02:28,775 but, you know, overall care delivery, uh, 52 00:02:28,915 --> 00:02:32,615 the cost has increased exponentially in the past, 53 00:02:33,025 --> 00:02:34,895 let's just say five years or so. 54 00:02:35,475 --> 00:02:39,095 That's something which, and, um, uh, as, as a, if I can say 55 00:02:39,095 --> 00:02:42,655 as a cancer doctor, as a leader in this space, uh, 56 00:02:42,675 --> 00:02:44,055 we continue to pay attention. 57 00:02:45,235 --> 00:02:47,215 Um, if I look at, um, 58 00:02:47,395 --> 00:02:50,055 and then of course, uh, everything else is happening outside 59 00:02:50,315 --> 00:02:54,375 and, uh, like, um, uh, a huge explosion of, uh, 60 00:02:54,725 --> 00:02:56,815 information, especially in the 61 00:02:57,135 --> 00:02:58,335 artificial intelligence space. 62 00:02:58,985 --> 00:03:01,325 And then the genomic space, uh, is really, 63 00:03:01,865 --> 00:03:05,045 and we are looking at internally, uh, similar. 64 00:03:05,585 --> 00:03:09,845 Um, uh, the, some of the really fascinating thing, uh, 65 00:03:09,885 --> 00:03:14,845 developments are, uh, in the genomic space, crispr, um, 66 00:03:15,065 --> 00:03:19,645 and then, uh, how, uh, artificial intelligence is going 67 00:03:19,645 --> 00:03:23,605 to help us, um, uh, in making some of this care delivery, 68 00:03:24,145 --> 00:03:26,765 uh, easier, uh, for our patients. 69 00:03:27,465 --> 00:03:32,445 Uh, and then, um, the drug shortage is something on top 70 00:03:32,445 --> 00:03:35,885 of our mind, and overall things are more 71 00:03:36,295 --> 00:03:37,445 manageable now. 72 00:03:38,065 --> 00:03:41,525 Uh, but that's something which we continue to keep a tab on, 73 00:03:41,985 --> 00:03:45,445 um, how we continue to provide the right drug 74 00:03:45,465 --> 00:03:49,285 for the right patients, uh, when we are in an environment 75 00:03:49,305 --> 00:03:50,605 of a drug shortage. 76 00:03:52,835 --> 00:03:54,315 - I can imagine that's something, you know, 77 00:03:54,315 --> 00:03:56,875 that really is a challenge for providers 78 00:03:56,875 --> 00:03:58,875 because they wanna provide the best care possible 79 00:03:59,055 --> 00:04:02,635 and really make sure their patients are, um, taken care of. 80 00:04:02,935 --> 00:04:05,595 You know, when you look at what you're doing today as well 81 00:04:05,595 --> 00:04:08,595 as, um, you know, what's on tap for the future, 82 00:04:10,025 --> 00:04:12,795 what really are, are you thinking through long term 83 00:04:12,815 --> 00:04:14,995 and short term when you look at drug shortages? 84 00:04:15,255 --> 00:04:19,115 How are you approaching that from the, I guess, department, 85 00:04:19,335 --> 00:04:20,795 um, perspective at Cleveland Clinic? 86 00:04:22,975 --> 00:04:27,115 - So, um, uh, so what we are doing several things. 87 00:04:27,655 --> 00:04:32,235 One, we have a constant communication between our 88 00:04:32,995 --> 00:04:36,035 pharmacy leadership and our, if I can say, 89 00:04:36,035 --> 00:04:37,075 our deceased leaders. 90 00:04:38,015 --> 00:04:40,915 So the pharmacy is kind of keeping a tab on 91 00:04:41,655 --> 00:04:45,995 what's happening in the market, uh, what, uh, 92 00:04:46,105 --> 00:04:48,875 what drugs are in the shortage list, uh, 93 00:04:48,875 --> 00:04:51,955 what we can expect in the next kind of 30 days. 94 00:04:52,375 --> 00:04:55,195 So then, so there's a constant communication between 95 00:04:55,815 --> 00:05:00,795 the pharmacy leadership and us, uh, and the clinicians. 96 00:05:01,455 --> 00:05:04,635 And then, um, we optimize, 97 00:05:04,725 --> 00:05:06,315 let's just say in a particular disease, 98 00:05:06,315 --> 00:05:08,475 there is a specific drug shortage. 99 00:05:09,415 --> 00:05:13,155 Our clinical leaders, um, get together 100 00:05:13,695 --> 00:05:17,955 and decide what's the next best thing we can, you know, 101 00:05:18,025 --> 00:05:19,115 provide, you know, 102 00:05:19,215 --> 00:05:21,715 and optimally treat our patients without 103 00:05:21,835 --> 00:05:23,675 compromising outcome. 104 00:05:24,295 --> 00:05:28,715 But so far, um, without really proactive approach 105 00:05:28,935 --> 00:05:33,395 and proactive, um, uh, engagement with, uh, the purchasing, 106 00:05:33,975 --> 00:05:38,195 uh, overall our Cleveland Clinic network, and in Ohio 107 00:05:38,855 --> 00:05:40,315 and Florida, uh, 108 00:05:40,415 --> 00:05:44,075 we are doing fairly well in making sure our patients 109 00:05:44,135 --> 00:05:45,315 get the right drug. 110 00:05:46,975 --> 00:05:48,355 - That's great to hear, and, 111 00:05:48,355 --> 00:05:50,475 and certainly so helpful to know 112 00:05:50,475 --> 00:05:52,635 and understand how that communication is happening within 113 00:05:52,635 --> 00:05:54,315 your divisions now. 114 00:05:54,545 --> 00:05:55,675 What are some of the things you're 115 00:05:55,675 --> 00:05:56,715 most excited about right now? 116 00:05:56,745 --> 00:05:57,745 What makes you nervous? 117 00:05:59,185 --> 00:06:02,685 - So, I'm really excited about, uh, the, uh, 118 00:06:02,825 --> 00:06:06,445 really rapid evolution of, you know, this technology. 119 00:06:06,785 --> 00:06:09,365 You know, so you, when I talk about, you know, 120 00:06:09,445 --> 00:06:12,205 I briefly mentioned about crispr, um, 121 00:06:12,545 --> 00:06:15,445 and then, uh, um, the, 122 00:06:15,705 --> 00:06:20,045 I'm sure you are really watching the synthetic biology space 123 00:06:20,935 --> 00:06:24,845 where, um, you know, it's a, it's a, it's a working together 124 00:06:24,865 --> 00:06:26,525 of the engineering technology 125 00:06:26,865 --> 00:06:31,165 and, um, um, our understanding of, uh, how 126 00:06:32,005 --> 00:06:33,165 a target, you know, 127 00:06:33,185 --> 00:06:36,605 and identifying an optimal target to developing targets 128 00:06:37,445 --> 00:06:38,725 specifically for that. 129 00:06:39,545 --> 00:06:42,085 Um, and, and then in addition, bringing 130 00:06:42,805 --> 00:06:44,245 artificial intelligence to that space. 131 00:06:44,745 --> 00:06:48,645 So I think, um, so some of these novel technologies 132 00:06:48,955 --> 00:06:50,405 that are in synthetic biology 133 00:06:50,785 --> 00:06:54,365 or crispr um, CAR T 134 00:06:55,115 --> 00:06:59,165 that always continues to make kind of change 135 00:07:00,145 --> 00:07:04,045 how we treat our patients in oncology space. 136 00:07:04,665 --> 00:07:07,605 Uh, it's, it's gonna be fascinating to watch, um, 137 00:07:08,425 --> 00:07:12,845 how new targets are identified, how new drugs are developed, 138 00:07:13,265 --> 00:07:17,285 and how fast we can bring them to our patients. 139 00:07:17,845 --> 00:07:19,565 I think that's going to be drastically 140 00:07:19,565 --> 00:07:21,965 different five years from now. 141 00:07:22,265 --> 00:07:25,765 Uh, i, I think we will do this things in a completely 142 00:07:25,765 --> 00:07:28,805 different way in the next step in the five, 10 years. 143 00:07:29,505 --> 00:07:33,085 And, and, and the exciting thing is a lot of, if I can say 144 00:07:33,905 --> 00:07:38,605 big players and, uh, not just the pharma, um, including 145 00:07:39,145 --> 00:07:43,285 Google and other people are investing billions 146 00:07:43,385 --> 00:07:46,965 of dollars in this space to make it easier 147 00:07:47,225 --> 00:07:49,005 or faster for all patients. 148 00:07:49,915 --> 00:07:50,965 What makes me nervous? 149 00:07:51,865 --> 00:07:56,655 So, um, the price tag come with this, uh, you know, 150 00:07:56,795 --> 00:07:59,775 um, I'm, and of course I'm from India and I'm sitting here. 151 00:08:00,395 --> 00:08:04,095 Um, we are privileged to, uh, make these drugs available, 152 00:08:04,955 --> 00:08:07,615 uh, for a, uh, a large segment 153 00:08:07,755 --> 00:08:09,975 of population here in the us. 154 00:08:10,515 --> 00:08:15,375 Uh, but when we look at global incidence of many diseases, 155 00:08:15,375 --> 00:08:19,615 especially cancer, uh, 70% of cancers will happen, 156 00:08:20,395 --> 00:08:22,215 uh, in low and middle income countries. 157 00:08:22,915 --> 00:08:26,495 So how we can make sure some 158 00:08:26,535 --> 00:08:29,855 of this technology like crispr, which cost three 159 00:08:29,875 --> 00:08:34,815 to $4 million per patient a CAR T, which may cost 160 00:08:35,325 --> 00:08:38,135 500,000 to a million dollar per patient, 161 00:08:39,115 --> 00:08:43,375 how do we make sure this is accessible 162 00:08:43,995 --> 00:08:47,735 for, uh, majority of population in the US 163 00:08:48,275 --> 00:08:49,295 and rest of the world? 164 00:08:49,975 --> 00:08:52,375 I think that's what make me nervous. 165 00:08:56,565 --> 00:08:58,625 - Got it. I, I think that's just fascinating 166 00:08:58,805 --> 00:09:00,465 and certainly, you know, so helpful 167 00:09:00,525 --> 00:09:03,185 to understand from your perspective as a clinician as well 168 00:09:03,185 --> 00:09:04,225 as a leader in this space 169 00:09:04,245 --> 00:09:07,625 and someone who, you know, is really focused on trying to, 170 00:09:07,805 --> 00:09:09,945 um, do the best you can with patients 171 00:09:10,125 --> 00:09:12,625 and really help them, um, in a significant way. 172 00:09:13,165 --> 00:09:16,505 Now, as we talked about, healthcare is changing quite a bit 173 00:09:16,605 --> 00:09:18,785 and, um, will continue to evolve, I'm sure, 174 00:09:18,885 --> 00:09:21,185 in the next three to five years, significantly. 175 00:09:21,525 --> 00:09:24,385 So, what do you see as being important 176 00:09:24,445 --> 00:09:26,625 for most effective leaders in healthcare 177 00:09:26,645 --> 00:09:28,705 to be successful in the next few years or so? 178 00:09:31,315 --> 00:09:35,975 - Um, so I, I think we really need to, 179 00:09:36,555 --> 00:09:39,055 um, and the leader need to be agile. 180 00:09:39,995 --> 00:09:44,895 Um, I think agility is going to be an important 181 00:09:45,645 --> 00:09:48,135 quality for the future leader. 182 00:09:48,915 --> 00:09:50,815 So, so why do I say that? 183 00:09:51,075 --> 00:09:54,575 Um, the agility or being agile is important 184 00:09:54,925 --> 00:09:58,615 because as a leader, you need to really 185 00:09:59,755 --> 00:10:04,655 pay attention to what's happening internally means within 186 00:10:04,715 --> 00:10:07,855 our teams, within our patient population, 187 00:10:08,315 --> 00:10:11,015 and what's happening within the society, 188 00:10:11,635 --> 00:10:14,095 and what's happening in the innovation space, 189 00:10:14,505 --> 00:10:15,815 which is surrounding us. 190 00:10:15,955 --> 00:10:18,415 And it can be in, in pharma world, 191 00:10:18,635 --> 00:10:22,695 it could be in the government, it could be in the IT world. 192 00:10:23,275 --> 00:10:26,735 So the innovation which is rapidly happening around us, 193 00:10:27,355 --> 00:10:28,855 what's happening in the society 194 00:10:29,435 --> 00:10:31,935 and what's happening with our patient population, 195 00:10:31,995 --> 00:10:33,815 what's happening with our own team. 196 00:10:34,875 --> 00:10:37,465 So if you look at oncology, 197 00:10:38,285 --> 00:10:39,985 if you look at our own team, 198 00:10:40,325 --> 00:10:42,865 and again, our team is the most important part 199 00:10:42,865 --> 00:10:44,465 of the whole care delivery. 200 00:10:45,155 --> 00:10:48,185 There is a concern about now burnout, 201 00:10:48,685 --> 00:10:52,745 and then there's a concern about, uh, the impact 202 00:10:52,745 --> 00:10:56,025 of all this novel technology on the pro caregivers. 203 00:10:56,325 --> 00:11:00,225 And, and, and so I think it's really important for 204 00:11:00,885 --> 00:11:05,025 the leader to be sensitive about those issues. 205 00:11:05,805 --> 00:11:10,265 Um, at the same time, um, try to manage, uh, 206 00:11:10,405 --> 00:11:15,225 our patient's expectation with this novel, um, 207 00:11:15,375 --> 00:11:17,145 therapeutic options. 208 00:11:17,765 --> 00:11:20,225 So you have to be really agile in making sure, 209 00:11:20,365 --> 00:11:22,345 and this, you know, balancing the, uh, 210 00:11:22,405 --> 00:11:23,585 the patient's expectation, 211 00:11:24,205 --> 00:11:27,625 the workload from our providers at the same time, 212 00:11:27,815 --> 00:11:32,145 this onslaught of new things coming at you, 213 00:11:32,765 --> 00:11:35,665 uh, from an outside, um, uh, system. 214 00:11:36,485 --> 00:11:39,305 Uh, but it's a really, really an exciting time 215 00:11:39,445 --> 00:11:41,985 and I'm really, really privileged to be in oncology. 216 00:11:42,085 --> 00:11:45,425 I'm really privileged to be in Cleveland Clinic, um, uh, 217 00:11:45,755 --> 00:11:50,345 which, and we really tried to deliver care, uh, 218 00:11:50,525 --> 00:11:55,205 across our enterprise, uh, here in Ohio 219 00:11:55,225 --> 00:11:58,965 or Florida, uh, and then in Abu Dhabi and London. 220 00:11:59,185 --> 00:12:01,965 So it's a really, an exciting time to be in healthcare. 221 00:12:02,965 --> 00:12:04,265 - Dr. Abraham, thank you so much 222 00:12:04,265 --> 00:12:05,665 for joining us on the podcast today. 223 00:12:05,665 --> 00:12:07,385 This has been such a fun conversation 224 00:12:07,645 --> 00:12:08,945 and really fascinating 225 00:12:08,945 --> 00:12:10,865 to hear about all the different things you're doing at 226 00:12:11,065 --> 00:12:13,705 Cleveland Clinic, um, to provide great care 227 00:12:13,765 --> 00:12:15,065 for cancer patients 228 00:12:15,065 --> 00:12:17,065 and certainly lead the way in, uh, 229 00:12:17,065 --> 00:12:18,545 technology and development in the future. 230 00:12:19,395 --> 00:12:20,745 - Thank you, Laura. It's, uh, 231 00:12:20,745 --> 00:12:22,265 really a pleasure to talk to you. 232 00:12:22,925 --> 00:12:24,105 Um, thank you so much.