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Welcome to Becker's Healthcare podcast. I'm Mariah Taylor,

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assistant editor, and I'm thrilled to be interviewing

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Stuart Goldman, chair of the department of children

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health and senior vice president of research at

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Phoenix Children's and the University of Arizona College

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of Medicine Phoenix on the podcast today. Doctor

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Goldman, thank you so much for being here.

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I'm so excited to dive more into the

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pediatric

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pediatric research you're doing and everything that that

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has produced.

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But before we get into my questions, I

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would just love to take a second for

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you to introduce yourself and tell us a

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bit about your background.

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Well, thank you. I'm also really excited to

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be here and to really talk about not

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only the wonderful things that are happening at

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Phoenix Children's and the University of Arizona,

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but in pediatric research in general.

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I am a pediatric hematologist

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oncologist

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who for the last

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35 years has practiced pediatric neuro oncology. I've

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become a brain tumor specialist.

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And I was originally at the University of

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Chicago where I trained and stayed on as

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Faulk Brain Tumor Center,

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ultimately becoming the division head of Hematology

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Oncology,

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Neuro Oncology and Stem Cell Transplantation,

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the longest division name ever created.

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And then in April of 2021,

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I moved to Phoenix Children's Hospital in the

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University of Arizona

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where I'm here to really witness

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firsthand

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the growth of an academic powerhouse

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and

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an institution that gives the best care to

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children throughout the state and our region.

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That's amazing.

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You have such a deep background in pediatric

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research. And so I'm wondering what are some

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of the current gaps in pediatric research within

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health systems?

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Well, I really think that we're in a

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critical time for the future

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of pediatric

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research.

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And when you think about

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some of the amazing things that have happened

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due to notable

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pediatric scientific achievements,

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for example,

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it was pediatricians

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that developed the Haemophilus influenza

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Type B

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treatments

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and gave us eradication of that invasive disease

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in many, many ways.

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It was pediatric

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pediatricians and researchers who developed

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and eliminated

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phenylketonuria

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in congenital hypothyroidism by doing congenital screening. It's

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thyroidism by doing congenital screening.

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It's pediatricians that help reduce the risk of

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sudden infant death with back to sleep and

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safe to sleep.

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It's pediatricians

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banding together

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to treat rare diseases for my beloved children's

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oncology group where we now have more than

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90%

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of kids with average risk leukemia

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surviving and being cured.

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And not to even mention the changes we've

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made in life expectancy

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with children and adolescents with cystic fibrosis,

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sickle cell disease

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and not to mention how we've decreased the

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risk of transmission of HIV from mothers to

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infants to now less than 1% of birth,

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all through the really

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intensive work of pediatric researchers.

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But

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I said this was a critical time because

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right now, if you look over the last

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few decades, less and less

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physician scientists are going into the pediatric research

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field.

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And that's really multifactorial

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from the lack of funding to support folks

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to the lack of time and mentoring. In

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fact, here at Phoenix Children's and the University,

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we've developed

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a cohorts

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of

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young,

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scientists who are just finished their training to

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be mentored in research

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of clinical,

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translational

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and how to develop that research career because

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it is becoming so and so difficult.

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And really another issue is the partnership between

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hospitals and academia. And that's one of the

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things that really made me feel lucky to

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be here at Phoenix Children's is this great

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partnership we have between the university

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and the hospital system.

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So there are some real, real changes here

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that are worrisome.

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In fact,

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I know

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just to mention the fellowship match for the

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20 5, 20 6 year just happened this

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last week

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and actually

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3 37

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spots were unfilled, that's 36%

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of the programs. And if you think

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about

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specifics

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like Peds GI,

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31% of the programs went unfilled,

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there was 99 positions filled, 23%

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23 until that's almost 19%

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nationally.

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HemOnc even more

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concerning nationally,

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31

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of the

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77 programs did not fill and 21

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0.6 percent of the national positions

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went unfilled. And I'm very concerned as I

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think many of

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the physician leaders about the future of our

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academic

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and research

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due to these trends.

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Absolutely.

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What do you think systems can do to

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create a strategy that brings in more of

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those senior and junior investigators to their communities?

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And how can they get buy in from

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the C suite leaders?

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Well, I think

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we should never forget that

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I reject that the C suite is different

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than your practicing physician,

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different than your academic institutions. We're all really

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here for one thing and that's to improve

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the lives of the children that we are

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so honored to serve,

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children we have served in the past and

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those will serve in the future. And so

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I think we're

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really all trying to get to the same

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place. There are competing interests, of course, right?

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We need to make sure that

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institutions stay financially sound.

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As in my old institution, I heard many,

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many times no margin, no mission.

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But one of the things we can do

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is

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we need to advance clinical excellence and innovation

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through the recruitment of these physician researchers and

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surgeon scientists.

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And I think that that speaks not just

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to us as scientists, but to our C

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suite because

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bringing in these people

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leads to more collaboration

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and innovation

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and helps to attract the very best physicians

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in health systems. And

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in my own institution, we've had

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tremendous buy in from our CEO

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who wants to make sure that we're doing

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this in a rigorous fashion to really return

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benefit to our patients and our community

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by bringing in really good researchers and training

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and

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retaining

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physician scientists for the future.

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I can't speak enough about the importance of

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mentoring so that not only do we make

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this investment

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in teaching our young folks how be physician

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scientists, but then encouraging them to retain

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this skill

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and to go on forward even fighting with

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all the lack of federal funding

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that is so difficult for us.

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Absolutely.

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Now it seems that your system is kind

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of at the top of things when it

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comes to pediatric research. So I'd love to

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know what are some of the advancements that

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you've seen at Phoenix Children's Research Institution,

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and what has changed or what has that

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done to change patient outcomes or care?

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Well, I think we can talk about

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things where

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we have an immediate impact

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and where we have an impact that's going

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to change for generations

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to come. You know, we've really

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between the collaboration

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between Phoenix Children's and with the support of

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our C suite that you just mentioned

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and the academic

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our partner, the University of Arizona and the

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Dean, we developed what's called the Phoenix Children's

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Research Institute at the University of Arizona,

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capitalizing

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on making sure that we combine our partnerships

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between a university institution and a strong children's

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health system.

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And that's really allowed us to recruit some

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of the top scientists from around the country.

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And I'll just mention 2 things just briefly

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that those top scientists are doing. You know,

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Doctor. Kalinichenko

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in the American Journal of Respiratory and Critical

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Care Medicine last year published a really seminal

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paper

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where he was able to take

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a mouse's

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genes and put them into a blastocyte and

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then actually grow

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a mouse's lung in a rat. And when

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you think about that, that's going to lead

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down the line growing children's lungs in an

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animal model so that we can have proper

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transplantation

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for those premature children who have their lungs

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affected by the necessary treatments to keep them

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alive when they're young or children who had

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other conditions that hurt their lungs.

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Another one of our recruits, Doctor. Callan,

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just published in the last year an exciting

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paper I believe in EMBO

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and this really showed that we always think

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that

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cancer cells spread because they we want to

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block those blood vessels and starve the tumor

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cells. But we found through some mechanisms like

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FOXF1 that maybe

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what we want to do is increase the

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blood flow to those tumor cells to stop

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metastatic potential. And this has really been shown

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in her model for

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lung cancers

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and childhood tumors that metastasize

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to the lungs. These are

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findings in an animal models that are going

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to down the line change the future.

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But we're currently doing real time research that's

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changing the lives of children from Doctor. Sitzman

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and his craniofacial

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team who are really making

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tremendous changes in the care of kids with

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cleft lip and palate,

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helping them to get good nutrition early on

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and have adequate feeding.

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You know, I can go on and on.

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Doctor. Kreuer and his work

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with kids with different types of movement disorders

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and cerebral palsy and looking at individual genetic

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causes and how we need to treat them

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differently and find answers.

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So there's so much going on. You know,

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I'd love to brag and tell you that

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we have over 700

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studies in different areas, almost 150 I'm currently

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accruing from the spectrum of cancer to kidney

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disease to development

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to avoiding

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social behavioral problems. And so

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the array of what we're doing is really

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exciting. And I have to tell you, even

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though

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I'm at the farther end of my career,

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I've never been more excited about the future

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of research

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and what pediatricians will do to change the

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world.

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I love that. So, let's talk about the

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future. What's coming up next in pediatric

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research?

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Well, you know, that's

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one of the really difficult questions because

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when you think you know the answer, you

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might be closing your eyes to some new

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fields. But I do see

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understanding

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individual

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differences,

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you know. Why is it that

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2 kids, the same weight,

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the same age,

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the same height,

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one takes

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25 milligrams of Benadryl and it's the appropriate

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dose, let's say, and falls fast asleep and

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the other ones running around like they're on

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fire because we have different

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pharmacogenomic,

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pharmacodynamic,

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pharmacokinetic

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differences.

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And so this leaves us this whole idea

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of precision medicine or what I really like

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to call individualized medicine.

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Understanding

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our genetic makeup and how we interact with

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the world and how we can best individualize

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the therapy to give the best outcomes with

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the least amount of toxicities.

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And we need to do that for so

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many diseases.

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And there's so many things that we can

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do to impact the world. So I see

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the difference with genomics,

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precision medicine

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and really excitement over some of the changes

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we can do for behavioral health to affect

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our health of our children and families.

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Amazing.

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Well, thank you so much for sharing some

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of what you're doing over there in Phoenix

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and for all of your expertise and your

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hard work for patients.

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It's been absolutely a pleasure talking with you

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on the podcast today.

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Thank you so much.