- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. James Abraham, chair
of hematology and medical oncology at Cleveland Clinic.
Dr. Abraham, it's a pleasure
to have you on the podcast today.
- Uh, thank you, Laura. It's, uh, an honor for me
to be part of this podcast.
- Well, fantastic. And you know, I'm looking excited
to our conversation because there's
so much happening in cancer care today and,
and really, I know Cleveland Clinic is on the forefront
of a lot of the different innovations and, and treatments.
So I'm looking forward to learning more
about what you have in store.
But before we dive into my questions,
can you tell us a little bit more
about yourself and your background?
- Uh, sure. Um, so I'm the department chair, uh,
for the hematology and oncology at, uh, Cleveland Clinic.
Um, I'm a breast cancer doctor.
Uh, so I've been doing breast cancer, uh,
for the last 20 years or so.
Um, uh, that's my patient care focus.
Um, and then of course, um, clinical trials
through N-S-A-B-P and N Energy
and many different large clinical trials group.
Uh, from an administrative perspective, for the last, um,
uh, four or almost five years, uh, I've been running one
of the largest, um, uh, hemo departments in the country.
And as you know, we have presence here in Ohio.
Uh, we have more than a hundred hematology oncology doctors
here in Ohio, and we have, uh, presence in Florida,
and we have presence in, uh, uh, in Abu Dhabi.
Um, so it's a global, uh, uh, organization, um,
delivering cancer care.
- Absolutely. Well, fantastic. Um, you know, and,
and I'm wondering from your vantage point leading such a
great institution at Cleveland Clinic, um, for cancer care,
what are some of the biggest issues
that you're following in 2024?
- So, um, so let me kind of say, you know, some
of the external issues and some of the internal issues.
Um, so external when we watch
and see what's happening, um,
and I'm talking about outside, purely outside
of the four walls of the hospital,
and we are looking at, um, um, um, uh,
the cost of care delivery.
Um, again, that's not unique for healthcare,
and it's not just unique for oncology, uh, space,
but, you know, overall care delivery, uh,
the cost has increased exponentially in the past,
let's just say five years or so.
That's something which, and, um, uh, as, as a, if I can say
as a cancer doctor, as a leader in this space, uh,
we continue to pay attention.
Um, if I look at, um,
and then of course, uh, everything else is happening outside
and, uh, like, um, uh, a huge explosion of, uh,
information, especially in the
artificial intelligence space.
And then the genomic space, uh, is really,
and we are looking at internally, uh, similar.
Um, uh, the, some of the really fascinating thing, uh,
developments are, uh, in the genomic space, crispr, um,
and then, uh, how, uh, artificial intelligence is going
to help us, um, uh, in making some of this care delivery,
uh, easier, uh, for our patients.
Uh, and then, um, the drug shortage is something on top
of our mind, and overall things are more
manageable now.
Uh, but that's something which we continue to keep a tab on,
um, how we continue to provide the right drug
for the right patients, uh, when we are in an environment
of a drug shortage.
- I can imagine that's something, you know,
that really is a challenge for providers
because they wanna provide the best care possible
and really make sure their patients are, um, taken care of.
You know, when you look at what you're doing today as well
as, um, you know, what's on tap for the future,
what really are, are you thinking through long term
and short term when you look at drug shortages?
How are you approaching that from the, I guess, department,
um, perspective at Cleveland Clinic?
- So, um, uh, so what we are doing several things.
One, we have a constant communication between our
pharmacy leadership and our, if I can say,
our deceased leaders.
So the pharmacy is kind of keeping a tab on
what's happening in the market, uh, what, uh,
what drugs are in the shortage list, uh,
what we can expect in the next kind of 30 days.
So then, so there's a constant communication between
the pharmacy leadership and us, uh, and the clinicians.
And then, um, we optimize,
let's just say in a particular disease,
there is a specific drug shortage.
Our clinical leaders, um, get together
and decide what's the next best thing we can, you know,
provide, you know,
and optimally treat our patients without
compromising outcome.
But so far, um, without really proactive approach
and proactive, um, uh, engagement with, uh, the purchasing,
uh, overall our Cleveland Clinic network, and in Ohio
and Florida, uh,
we are doing fairly well in making sure our patients
get the right drug.
- That's great to hear, and,
and certainly so helpful to know
and understand how that communication is happening within
your divisions now.
What are some of the things you're
most excited about right now?
What makes you nervous?
- So, I'm really excited about, uh, the, uh,
really rapid evolution of, you know, this technology.
You know, so you, when I talk about, you know,
I briefly mentioned about crispr, um,
and then, uh, um, the,
I'm sure you are really watching the synthetic biology space
where, um, you know, it's a, it's a, it's a working together
of the engineering technology
and, um, um, our understanding of, uh, how
a target, you know,
and identifying an optimal target to developing targets
specifically for that.
Um, and, and then in addition, bringing
artificial intelligence to that space.
So I think, um, so some of these novel technologies
that are in synthetic biology
or crispr um, CAR T
that always continues to make kind of change
how we treat our patients in oncology space.
Uh, it's, it's gonna be fascinating to watch, um,
how new targets are identified, how new drugs are developed,
and how fast we can bring them to our patients.
I think that's going to be drastically
different five years from now.
Uh, i, I think we will do this things in a completely
different way in the next step in the five, 10 years.
And, and, and the exciting thing is a lot of, if I can say
big players and, uh, not just the pharma, um, including
Google and other people are investing billions
of dollars in this space to make it easier
or faster for all patients.
What makes me nervous?
So, um, the price tag come with this, uh, you know,
um, I'm, and of course I'm from India and I'm sitting here.
Um, we are privileged to, uh, make these drugs available,
uh, for a, uh, a large segment
of population here in the us.
Uh, but when we look at global incidence of many diseases,
especially cancer, uh, 70% of cancers will happen,
uh, in low and middle income countries.
So how we can make sure some
of this technology like crispr, which cost three
to $4 million per patient a CAR T, which may cost
500,000 to a million dollar per patient,
how do we make sure this is accessible
for, uh, majority of population in the US
and rest of the world?
I think that's what make me nervous.
- Got it. I, I think that's just fascinating
and certainly, you know, so helpful
to understand from your perspective as a clinician as well
as a leader in this space
and someone who, you know, is really focused on trying to,
um, do the best you can with patients
and really help them, um, in a significant way.
Now, as we talked about, healthcare is changing quite a bit
and, um, will continue to evolve, I'm sure,
in the next three to five years, significantly.
So, what do you see as being important
for most effective leaders in healthcare
to be successful in the next few years or so?
- Um, so I, I think we really need to,
um, and the leader need to be agile.
Um, I think agility is going to be an important
quality for the future leader.
So, so why do I say that?
Um, the agility or being agile is important
because as a leader, you need to really
pay attention to what's happening internally means within
our teams, within our patient population,
and what's happening within the society,
and what's happening in the innovation space,
which is surrounding us.
And it can be in, in pharma world,
it could be in the government, it could be in the IT world.
So the innovation which is rapidly happening around us,
what's happening in the society
and what's happening with our patient population,
what's happening with our own team.
So if you look at oncology,
if you look at our own team,
and again, our team is the most important part
of the whole care delivery.
There is a concern about now burnout,
and then there's a concern about, uh, the impact
of all this novel technology on the pro caregivers.
And, and, and so I think it's really important for
the leader to be sensitive about those issues.
Um, at the same time, um, try to manage, uh,
our patient's expectation with this novel, um,
therapeutic options.
So you have to be really agile in making sure,
and this, you know, balancing the, uh,
the patient's expectation,
the workload from our providers at the same time,
this onslaught of new things coming at you,
uh, from an outside, um, uh, system.
Uh, but it's a really, really an exciting time
and I'm really, really privileged to be in oncology.
I'm really privileged to be in Cleveland Clinic, um, uh,
which, and we really tried to deliver care, uh,
across our enterprise, uh, here in Ohio
or Florida, uh, and then in Abu Dhabi and London.
So it's a really, an exciting time to be in healthcare.
- Dr. Abraham, thank you so much
for joining us on the podcast today.
This has been such a fun conversation
and really fascinating
to hear about all the different things you're doing at
Cleveland Clinic, um, to provide great care
for cancer patients
and certainly lead the way in, uh,
technology and development in the future.
- Thank you, Laura. It's, uh,
really a pleasure to talk to you.
Um, thank you so much.