Oncology Unscripted With John Marshall

John Marshall
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Oncology Unscripted with John Marshall, MD brings you a unique take on the latest oncology news including business news, gossip, science, and a special in-depth segment relevant to clinical practice.

  1. Oncology Unscripted With John Marshall: Episode 28: Are We Watching a Global Evolution in Cancer Care Leadership?

    MAR 25

    Oncology Unscripted With John Marshall: Episode 28: Are We Watching a Global Evolution in Cancer Care Leadership?

    MedBuzz: After a trip to the Galapagos, Dr John Marshall reflects on evolution in nature, cancer, and medicine. From Darwin’s observations to the rise of AI and precision oncology, he explores how rapidly cancer adapts, how technology is reshaping care, and why the future of medicine must still preserve the human touch. Main Topic: In this episode of Oncology Unscripted, Dr John Marshall reflects on a practice-changing cholangiocarcinoma study from China and what it reveals about the rapid evolution of cancer research worldwide. As novel therapies transform care and China expands its investment in science while the US devests, he asks whether we can keep pace and the impacts of the global evolution of in oncology. Interview:   Watch now as Dr John Marshall sits down with Dr Louis Weiner, director of Georgetown University’s Lombardi Cancer Center, for a candid conversation about leadership, scientific change, and the future of oncology. Reflecting on innovation, institutional transition, and the pressures reshaping cancer research, they explore what it means to evolve as a leader and honoring the work and the people. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

    30 min
  2. Oncology Unscripted With John Marshall: Episode 27: Groundhog Day, The Ice Palace, and $25 Trillion Cancer Costs

    FEB 23

    Oncology Unscripted With John Marshall: Episode 27: Groundhog Day, The Ice Palace, and $25 Trillion Cancer Costs

    MedBuzz: Watch now as Dr Marshall discusses the growing instability at the FDA, including job cuts, leadership turnover, and structural reorganization. Main Topic: This episode of Oncology Unscripted explores the projected $25 trillion global cost of cancer care, rising cancer incidence, and declining mortality, all set against political and funding uncertainty in frozen Washington, DC. Interview: In this episode of Oncology Unscripted, John Marshall, MD, sits down with Richard Pazdur, MD, former director of the FDA’s Oncology Center of Excellence, for a candid discussion about his transition to and from the FDA, reflecting on what’s been built and what is at risk of being lost. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

    33 min
  3. Oncology Unscripted With John Marshall: Episode 26: Microbes, Mutagens, and Mortality: CRC in a Younger Generation

    JAN 28

    Oncology Unscripted With John Marshall: Episode 26: Microbes, Mutagens, and Mortality: CRC in a Younger Generation

    Oncology Unscripted at ASCO GI: People, Pipelines, and Precision John Marshall, MD: Hello, everybody, from San Francisco, California. My name is Dr. John Marshall, and you are on—maybe unwisely—Oncology Unscripted. But thanks for joining me. I love this meeting, but let's first talk about the news of 2026. Top of the line is: we're out to get new countries. Now, I'm sort of running for mayor of Havana. I don't know if it's important that I, in fact, speak Spanish—because I don't. I speak a little bit of French. My Spanish is terrible. But maybe it won't matter, because I am who I am, and they're looking for just my kind of person to go be mayor of Havana. So, if you see that and you get a chance to vote, vote me in. I love the whole country of Cuba—it's beautiful. Second, in today's newspaper—I couldn't believe it—this guy named Dr. Oz, you know him, he's an actual cardiologist, believe it or not. Then he became the talk show host. And then, for some reason, he's the head of CMS at this point—one of the head overseers of healthcare here in the country. And he said his position was that alcohol is good. This couldn’t have made me happier. This couldn’t have been a better holiday present, because I'm a big alcohol fan myself, and now I can feel less guilty about it. His rationale is that if you drink more, you'll be with people more, you'll be more relaxed, and the camaraderie will pay off in terms of lessening your anxiety and stress—and the world will be a happier place. So, don’t be smart. We don't want people in our country to be intelligent or educated. Drink more. Be less educated. You'll be happier in the long run. That's the official position of our government today. Probably the most important new news from a healthcare perspective is that the House approved an extension on the Affordable Care Act. This has been an incredible threat and uncertainty for so many of our patients. The people who depend on that health insurance could never afford cancer care without it. Having the extension of the Affordable Care Act—for them—talk about lowering your stress. Maybe better than alcohol is actually being insured. I don’t know if you go to many meetings out there, but this one is called GI ASCO. It's always in San Francisco. It's always in this building that I'm standing in now. I have perfect attendance. I’ve been to every one since they started. You should get a special ribbon for that. I think there’s probably one down there for that. They are a little bit more environmentally conscious—no plastic covering to this. Just a piece of paper. Totally recyclable old name badge. Way to go, ASCO, on that. Do you go to meetings or don’t you? I come to this one for a very, very important reason. I come to this one for the people. It’s a small meeting. It’s just the GI gang, both from the industry side and the academic side. It’s a very heavy global presence that comes. I know almost everybody here, and there are only like 3,000 people here. There’s time to stop and say hello to almost everybody you know—give them a hug, share a little COVID, maybe flu, with each other—but then know that you are connected again. And this is something Zoom doesn’t do. This is something you can’t check on—somebody’s kids—over a meeting. But that’s one of the main reasons I come. I love these people. These are people that share in our values and our motivation to try and cure cancer. We all take care of the group of cancers—GI cancers—which are the most common, most fatal cancers on our planet. We are inspired to do this. We know it’s a steep climb, and we do it together. I’m so very pleased to be a part of this community, and it’s the main reason I come. Main reason—people. Second reason—pipelines. There’s a lot of data out there, and there are a lot of companies here that finally have new products for GI cancers. We’ll talk a little bit about that in more specific detail, but if you just look at the number of groups that are here—the number of people who’ve got innovative, new approaches—whether it’s novel immunotherapy, targeted agents, combinations of those, targeted antibodies that are delivering toxic payloads—we’re seeing waterfall plots that we haven’t seen in decades. So, response rates, survivals, progression-free survivals that really compare favorably to our traditional chemotherapy approaches. We are on the cusp of a true revolution in the world of GI cancer. And, surprisingly, one more—led by the world of pancreatic cancer. So, let’s talk a little bit about precision in GI oncology. The biggest breakthroughs that we are seeing at this meeting have to do with RAS targeting. There are a bunch of RAS drugs out there now. There are some that are more out in front than others. There are some that are degraders that break down the RAS. There are some that block pan-RAS, so they hit a bunch of RAS targets. There are some that are very specific for one particular kind of RAS mutation—and they’re working. Now, they’re not curing everybody. But we’re seeing great waterfall plots, even with single agents, in a disease that we haven’t cracked in a long, long time—and that is pancreatic cancer. So, we are all incredibly optimistic about what we are seeing. We are anticipating approvals this year for some—maybe one or more—of these agents. We’re excited about the possibility of combining these RAS-targeted agents with things like immunotherapy or others. We are already starting to try and think about: is the pan-RAS better than an isolated targeted RAS? What are the toxicities? How are we going to manage it? Because we’re fully expecting these drugs to get approval and to get rapidly incorporated into our day-to-day management. First, pancreas cancer. We’re seeing it in biliary cancers. We’re seeing it in stomach cancers. Where we’re not seeing it just yet is in colorectal cancer. And I would’ve predicted a long time ago that colon was going to be the easiest nut to crack. And yet, we’ve made progress. But in fact, what we’re going to see now—biliary, hepatocellular, pancreas cancer, stomach cancers—we’re going to see a lot of evolution over the next several years. A good friend, and really a fabulous speaker, Dr. Andrew Ko from here in San Francisco—UCSF—was the discussant just an hour ago in this building, where he did a great job of setting the stage of both the excitement for the future, but also a healthy respect for what we are going to need to understand to march forward quickly but effectively for all of those patients we’re sitting across the exam room from—that need our help. So, precision medicine is finally making its way to GI cancers—led by the RAS wave that we are seeing. So, stay tuned. You’re going to have new drugs out there. There’s going to be competition. A lot of people talking about it. As we talked a lot about pipelines and the new drugs that were coming out, one of the common questions we get is: what's missing? What have we not been studying well enough? And I have a pretty consistent answer—and that is the microbiome. We don’t understand the impact of those bacteria on us, on our health, on the effectiveness of drugs, etc. And until we really start digging into that science, I don’t think we’ll see that next wave of innovation. So, the answer is microbiome. So, why do I come to GI ASCO every year? Well, you already know the number one reason—that’s people. I love them. They’re my family, and I love to catch up with them just like you do with your family around the holidays. This is my family visit for the holidays. Second—pipelines. Understanding what’s out there today, what’s coming, and how we are going to cure patients with GI cancer. It’s going to be through these pipelines. And then last—the latest data. And that’s around precision medicine. We are about to embark on a wave of therapies that target RAS, and you’re going to start to see cancer shrink as these new drugs come into play. Our job, then, over the next couple of years, is to take this new understanding, this new ability to control precision medicine, and apply it to our patients—to cure more patients with GI cancers. Thanks for joining me from San Francisco. Totally unscripted. John Marshall, Oncology Unscripted. Microbes, Mutagens, and Mortality: CRC in a Younger Generation John Marshall, MD: John Marshall Oncology Unscripted. A lot of good data coming out on all sorts of things. You know, I'm a colon cancer guy, so I really want to talk about two clinical trials in the colon cancer space. One was a paper in Nature—it's actually a few months old—but, you know, I keep seeing all these young people with colon cancer, and I keep thinking: it's the microbiome. It's gotta be. And this paper actually found a version of E. coli that produces a toxin that, if you're exposed to it at a young age—say 10, 11, 12 years old—it dramatically increases your risk of getting colon cancer later. Now, I sort of didn’t think of it as one bacterium causing one toxin causing a toxicity. I always thought it was more of a gamish—what swamp do you have? What's the nature of your rainforest, your bacteria in the colon, that's causing it? But what I'm excited about is that we're continuing to see, week after week, month after month, new data that supports a better understanding of the microbiome—one that we hope will translate into not just identifying people who are at risk for early-onset colon cancer, but, as you know, other diseases as well. And as a related story—this comes out of Cancer Investigation—patients who are taking GLP-1 drugs had lower colon cancer death rates. So basically, they looked at colon cancer patients, and the strongest signal was in those who were obese. But if you were on a GLP-1 versus not on a GLP-1, your survival was much better on one. So, again,

    34 min
  4. Oncology Unscripted With John Marshall: Episode 25: New Hope in GI Cancer Care

    12/18/2025

    Oncology Unscripted With John Marshall: Episode 25: New Hope in GI Cancer Care

    MedBuzz Tariffs, Taxes, and Trade-Offs: Can Raising Taxes in the UK Get You Cheaper Drugs in the US? John Marshall, MD: John Marshall for Oncology Unscripted. There's been all sorts of stuff going on out there in healthcare—in the business of healthcare—and a recent article that was just published in The New York Times told us something about the relationship between the National Health Service, how patients get access to drugs there in Great Britain, and our relationship with them and the tariffs. You're like, how could the tariffs have anything to do with the National Health Service? Well, let me give you a very short little background, if you don't know already, on the National Health Service—Britain’s public health system. The Brits love it. It's tax-based. It's not fancy, it's not frilly. But if we're going to bring in some new medicine or some new expensive therapy—whatever it is—the budget has to be balanced.So, either they have to remove something from what the patients have access to, or they have to raise taxes. And there is a committee known as the NICE committee, the National Institute of Clinical Excellence—staffed by physicians that, in fact, governs that.  You're thinking, where is Marshall going with this?Well, where he is going—and The New York Times presented this—is that because of the tariffs, right? Britain makes some drugs, and we import them here and use them. Well, if the tariffs are in place, those drugs will be more expensive to import. And the whole idea behind the tariffs is to make it so that more Americans are doing the manufacturing. Well, the Trump administration and the National Health Service just made a new deal where the Brits will get access to more drugs—so they'll raise their expenses, if you will. And it's going to hit the bottom line over there...because they're going to have access to medicines that they don’t currently have access to. In exchange, the U.S. is going to say, “Well, we'll waive those tariffs on drugs you import.” So, it is access over here for an economic change—an international economic change—around the tariffs. I have no idea how this is going to work out. I didn’t really understand all the math—were taxes going to go up in Great Britain? Were they going to call it a wash because the tariffs were not going to be in place? I don’t know. The good thing for patients in the UK is that they're going to have more access to more medicines. What I worry about is that it'll come on the backs of either going into debt—if the National Health Service goes into more debt, sort of like our healthcare system—or, in fact, they raise taxes, or somehow they magically make the budgets balance. So, we need to look ahead to 2026 and see just what happens with this UK National Health Service–Trump tariff deal that was just reported in The New York Times. Stay tuned here for more updates on Oncology Unscripted. [03:04] Editorial/Main Topic What I Tell Every New Patient With Cancer John Marshall, MD: John Marshall for Oncology Unscripted.I start almost every new patient appointment by talking with the patient and saying that I—I don't really know why people get cancer. We memorize lists of what we're supposed to do and what we're not supposed to do, but, bluntly, almost everybody sitting across the room from me didn't do anything on the bad list, and yet here they are, sitting there with cancer. It seems to me—and I think this is popular science thinking as well—that we probably all get cancer all the time. But our bodies actually have outstanding spell checkers and an outstanding functional immune system that can see early cancers and fix them before they cause any trouble. So, what that actually means, then, is that those cancers that make it—those cancers that survive through the spell checker or through the immune system—must have figured out a way to get around the spell checker, or have broken the spell checker, or maybe are hiding from the immune system. And so, almost all of our new research going on right now in cancer medicine is either trying to fix the spell checker—and by this, I mean targeted therapies, signaling pathways, et cetera—or it's trying to turn back on, wake back up, or uncover the tumor from the immune system so the immune system can go in and do its job. And so, I think what you see at almost any conference nowadays focuses on those two approaches. It's not some new chemotherapy, although chemo continues to be very important and has cured a whole lot of people, so don't get me wrong about that. But what we're seeing in terms of innovation has a lot to do with improving the immune system, measuring the immune system, having better immunotherapy or immunotherapy combinations, and, at the same time, uncovering the molecular abnormalities of our cancers and having targets to those—and, in some cases, combining those with novel therapies as well. So, be on the lookout for the next innovation: either fixing your spell checker or fixing your immune system. But, in support of that, let's look at some of the coolest, latest data that's practice changing in our world today.  John Marshall for Oncology Unscripted. [05:42] Interview New Hope in GI Cancer Care: A Candid Conversation with Dr Yelena Janjigian John Marshall, MD: Hey, everybody out there in videoland or maybe you’re in podcast land walking your neighborhood. Maybe you have a pit mix dog you're walking because she hasn’t been out in a while, but wherever you are, this is for Oncology Unscripted, and I am a lucky guy because I am joined today by not only a great friend, but also someone who is really setting the standard of care for us in so many ways in GI cancers, and that's Dr. Yelena Janjigian. Yelena, how is New York City today? How is it up there? Yelena Jangigian, MD: Thanks for having me, Donna. It's great. New York is the best place to be. It's beautiful and sunny, getting ready for holiday season. It's always good to catch up with you and talk research and talk gastric cancer and esophagus cancer outcomes. John Marshall, MD: Do the stores already have, like, decorations ready to go up there? Yelena Jangigian, MD: I have not been out, but I've noticed some things here and there in offices. John Marshall, MD: What do you mean you haven't been out? You live in the hospital, in the clinic, don't you go out? Yelena Jangigian, MD: Not out in shops, but I've noticed a few, like, you know, holidays, actually. Some of them are actually skipping Thanksgiving and going into holiday season decorations in random offices. So, but, you know, the spirit is, you know, cheerful in New York. John Marshall, MD: It is a good time of year. I know you very well, and I know lots of our listeners know you very well. Give us a quick little bio on what you're doing right now. Yelena Jangigian, MD: I'm a physician-scientist working at Memorial Sloan Kettering Cancer Center, focused on advancing care and helping patients with esophagus and stomach cancer live longer using both targeted and immunotherapies. Our lab is focused on trying to understand how we can overcome resistance to some of these medications using both tissue culture and other models. And, of course, I also lead a big group at Memorial Sloan Kettering Cancer Center. We have 45 oncologists all focused on one mission: to improve cancer care for worldwide options for gastric cancer, but also anywhere from esophagus down to the anal canal. So, it's a big group of very dedicated individuals.  John Marshall, MD: So now I know why you haven't been outside. Because you haven't slept, you haven't left. Yelena Jangigian, MD: Annual review time. A lot of paperwork.  John Marshall, MD: Well, let's get into the weeds a little bit on how you are, in fact, helping to lead the improvement in outcomes for patients. But before we jump in, as an old guy in this space, I do have frustration that we in the GI cancer world haven't made more progress compared to our friends in some other cancers. And I know in upper GI and stomach and adenos, etc., precision medicine hasn't been consistent. Things that work in the metastatic setting haven't necessarily worked in the adjuvant setting. It's taken us a long time to get precision medicine targets that are viable for therapies, etc. What are your thoughts about that and why that might be so? Yelena Jangigian, MD: So, yeah, I think it's important to start from basic knowledge that these diseases can be quite heterogeneous. And even in biomarkers such as HER2, cut-and-paste approaches from, for example, breast cancer into gastroesophageal cancer have not been the best way to do it. In fact, understanding the co-occurring alterations in our disease—the RAS pathway activation, the PD-L1 co-occurring with HER2—is what made the major milestone in the breakthrough in first-line setting beyond trastuzumab. So, I think understanding that this disease, in its nature, because of the nature of the GI epithelium, is more complex but also more heterogeneous than some of our other solid tumors is really critical. And also, because it's a rare disease in some countries, uniform and reflexive testing of biomarkers, where you get enough of a critical mass of data into the clinic so that you understand how each individual subset of a subset—for example, within HER2 tumors, p53-mutant tumors may do differently than p53 wild-type, RAS amplified vs RAS neutral—things like that. Until we do things in larger scale really going forward for all patients, we won't understand this nuance because in colon, breast, lung—the big three—there's more data, breadth and depth, these discoveries can be made. John Marshall, MD: I was thinking about the idea of mostly colon cancer, and we've been seeing with IO therapy, where we're going to go in a minute, that even in MSS colon cancers, if it's primary disease, we are seeing responses when we would never see them in metastat

    22 min
  5. Oncology Unscripted With John Marshall: Episode 24: How Do We Translate MRD Innovation Into Everyday Oncology Practice?

    12/15/2025

    Oncology Unscripted With John Marshall: Episode 24: How Do We Translate MRD Innovation Into Everyday Oncology Practice?

    MedBuzz: From Hormones to Heroines: Couric, Cancer, and the Case for Change John Marshall, MD Hello, everybody. John Marshall for Oncology Unscripted, coming to you from my now almost empty office. I've been in this office for, gosh, 20-plus years. It's the big office. You may or may not know I stepped down as the division chief here at Georgetown. We planned it—I wanted to do it a while ago. They said no. So, I finally got to step down because I wanted to do some other things. I get a lot of time back from meetings I really didn’t want to go to in the first place, so I’m happy about that. And it’s enabled me to get back to the world of clinical cancer research and to try and innovate in our space and do a lot less administrative things. So, I am glad for the clean-out, moving down to a smaller office in a fresh region. Probably one of the last times—maybe the last time—I film from this spot.  But I wanted to take some time to review some high-level things that have changed in a big way just in the last week or two. The one that struck me the most is that there's been a change in black box warnings around hormones for postmenopausal women. I lived this too, where we went from hormones being a good thing—and all postmenopausal women were more or less taking them—to then it was unopposed estrogens were evil. And then the cancer lobby—and the breast cancer lobby—really was responsible for making it so women stopped taking hormones. We made it so terrifying that hormones were going to cause breast cancer that, you know, certainly oncologists weren’t prescribing it. GYNs stopped doing it. Primary care docs stopped doing it because no one was really willing to take the risk. And I think about the suffering, quite honestly, that postmenopausal women have endured since this time. It is really, really remarkable. And only now—only now—that people have gone back to actually look at the clinical trials and look at the studies, they actually pretty clearly show that hormone replacement is not bad for these people. In fact, if you look at the colon cancer literature, surprisingly, there was evidence that it decreased the risk of getting colon cancer. And even despite that, they didn’t want to change it around. So, I am excited about that black box warning change. If you’re a postmenopausal woman or you know some that are around you, make sure that if they’re interested, there are new options for those patients. But there’s a second warning that has been installed, and this is around 5-FU and DPD testing—dihydropyrimidine dehydrogenase testing—for 5-FU clearance. Why I think it's a big deal is not only is it an updated Black Box, but NCCN has embraced it. I think it’s a big enough deal that I hope you will click in and watch my interview with Howard McLeod, who is really the world’s expert in this space, about what we should be doing, how to do it, and some of the practical aspects of that. So, make sure and click on that interview and watch it. It’ll be worth your time. All you clinicians out there should do it. Now, whether or not it will become routine, whether or not it will become standard of care, whether or not you’ll get sued if you don’t do it—those things will evolve. But I do think it will be part of your everyday life. So, good to keep up to speed on that. And then lastly, sort of an emotional note to make—and that is, this is the actual 25th anniversary of something I bet you remember. That’s when Katie Couric had a colonoscopy on television, and it was on a morning TV program, The Today Show. She did that because, of course, her husband had had colon cancer, and she became quite a strong advocate. Her sister Emily later developed pancreas cancer and died of that, and she’s been very involved in Stand Up to Cancer and so many things. But I think back about that moment when Katie Couric said, “You’ve got to be getting your colonoscopy.” And the reason it comes up is that, one, we’re giving her a 25th anniversary award here at Georgetown—one of our Luminary Awards. So, we’re very excited about that. I’m going to get to see her later this week and thank her in person. But I was also thinking about the impact that I believe she has had on the number of people who get colon cancer. If you really do the math, the interventions that have changed with colonoscopy, etc., in the United States have probably reduced the number of people who get colon cancer every year by about 20,000. Now, 150,000 people get colon cancer every year. It would be much higher than that if we didn’t have effective screening. So, screening works—fewer people in our clinics—and we need to applaud her for all that she has done. So, that’s all the gossip that’s fit to print for this session of Oncology Unscripted. I hope it gives you a little something to think about, look up, or consider as you move forward in your day tomorrow. John Marshall. See you later. Editorial: How Do We Translate MRD Innovation Into Everyday Oncology Practice? John Marshall, MD John Marshall, Oncology Unscripted. I've talked about this a bunch on our program, and this is the impact of blood-based genetic testing on cancer care—maybe other health care problems as well. And the couple of ways we do blood-based testing: one is to look for mutations from a patient with a known cancer. But we're also using blood testing to see whether or not there is still cancer around—so-called minimal residual disease. And they're similar in technology but different in terms of how we're using them. A lot of us out there are not using the MRD testing, whether it's tissue-based or not, because the truth is we don't really know what to do with that result. If it's negative, do I not give adjuvant chemotherapy? If it's positive, do I give more adjuvant chemotherapy? What if it flips? What if it doesn't? Et cetera. So there's a lot of unknowns, but there is this wave of data that continues to come out. San Antonio Breast coming up has new data around this. We've seen it at ASCO. We've seen newer publications more recently that suggest dramatic differences if your test is positive after surgery versus if it is negative, with hazard ratios that exceed 20. This is prediction of cancer still being around. And yes, the negatives are not perfect, but they, too, are pretty good. So, we talk about finding the right patient to give treatment to in the adjuvant setting.I am certain that some sort of MRD testing is going to be part of this. And I was lucky enough to hear a fabulous lecture by a very, very good friend of mine, Dr Scott Kopetz from MD Anderson, who summarized the current data set around this and says that this is not going to go away. This is the inevitable. The question is: how are we, as health care providers, going to use this data to guide our patients, to guide our therapies, to improve efficiency around all kinds of therapy—most importantly, right now, adjuvant therapy? So, review these data. Look at those hazard ratios. Decide whether or not you want to begin incorporating MRD testing into your general day-to-day care. And let's see what 2020 says with regards to treatment opportunities, clinical trials, et cetera, moving forward. John Marshall for Oncology Unscripted. Interview: Can Pharmacogenomic Testing Make Oncology Safer? A Candid Conversation with Dr Howard McLeod John Marshall, MD: Hey, everybody out there, John Marshall for Oncology Unscripted. You might notice that my studio is a little bit more bare today. One of the reasons is that I’m moving. They’re kicking me out of this office for a smaller office. That’s what you get when you get old. It’s discrimination—age discrimination. It’s actually job-appropriate job discrimination. But we’ve got some blank walls in here, and we’ve got a lot of bright content, and I am so excited to introduce to you all—if you don’t already know him, pretty famous guy in his own right—Dr. Howard McLeod. Howard and I have known each other for decades. We can say that, I think, with some certainty. And I want him to introduce himself, because what we’ve got to talk about is critical to almost everybody’s practice who’s listening in. Howard, welcome. Give us a little background on who you are and what your area is. Howard McLeod, PharmD: Thank you, John. It’s great to be on your program. I’m an avid listener, first-time appearer, as they say. I got dragged into this area of pharmacogenomics the hard way. A little girl nearly died of her therapy instead of her leukemia when I was a fellow at St Jude’s. We ended up finding the gene responsible for that. Then a similar situation when I was over in Glasgow—a man got one dose of 5-fluorouracil and nearly died. So genetics as a way of predicting toxicity has been the theme of my life going forward—lots of implementation work, lots of large clinical trials and such. Fast forward to our work at Utah Tech University: a lot of what we’re doing now is asking, “What do we do with this? How do we make it work in the real world?” Making it work at Georgetown is one thing. Making it work at a small practice “in the wild” is a totally different thing. So, how do we implement this in all places, as opposed to just a few big centers? And the dihydropyrimidine dehydrogenase story that we’re going to talk about today is just one example. There’s a lot of activity around supportive care—Which pain med? Which antiemetic? Which antidepressant?—but this specific example is very much a toxicity example, and I’m looking forward to discussing it with you. John Marshall, MD: Let’s drill into this. One of our themes for this season right now is the increased utilization of molecular profiling—identifying positive signals for therapies. I’ve always thought that pharmacogenomics—because I work with a guy named John Deeken here, who is a you, John—yeah, and he’s been p

    24 min
  6. Oncology Unscripted With John Marshall: Episode 23: The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?

    11/18/2025

    Oncology Unscripted With John Marshall: Episode 23: The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?

    MEDBUZZ [0:00:05] When the Sources of Trusted Information Change—Who Do We Believe? John Marshall, MD: Happy whatever day it is today when you're watching this. John Marshall for Oncology Unscripted. A little bit of a rainy day here in Washington, DC. It's been a little bit of a weird time here in Washington, DC—even weirder than it normally has been. Let's start with a little of the business of our world today—the business of oncology. You may have seen that we have a new National Cancer Institute director: Dr Anthony. Professor of medicine, he's kind of a basic science guy, but he's also a medical oncologist from Dana-Farber. Would you take that job if it was offered to you? I knew some of the candidates who were in line for it—or the finalists—and you'd really have to want that job to take it right now, because of all the unsettledness at the NIH in general, et cetera. So, I'm grateful that this very smart person has said yes to the job. Now, what he does—one of his areas of expertise—is programmed cell death, which is sort of a subtle way of getting a cancer cell to kill itself, right? So maybe, just maybe, he'll use some of that expertise to help in the shifting of government. A little programmed cell death around here might go a long way. So, fingers crossed that he succeeds in maintaining and growing the research that we are doing in cancer, much of which is sponsored through the National Cancer Institute. So, fingers crossed. But as soon as he gets the job, what happens? Well, we shut down the government. We've done this before. It is weird in Washington when the government shuts down. Whether it's patients who now don't have a job for the moment and who risk not having health insurance to receive their ongoing cancer care—in my case—or care in general out there.We're clearly seeing an impact on patients. We're clearly seeing an impact on government operations. I'm supposed to fly to Florida to get measles, maybe, this coming weekend, and I'm not sure we will do it because—who knows if there'll be air traffic controllers available? Would you go to work if you weren't getting paid? I had a recent call with an NCI colleague who is going to work, who is seeing patients, and is trying to manage things—but is uncertain about whether they will be paid. I also happened to come across recently somebody in the medical center who works up in McLean. If you know what offices are in McLean, I'll let you figure that out—sort of secret spy stuff. Normally, they're incredibly busy, but because there aren't any other government activities going on, they're kind of sitting there saying, "Well, we can't do what we normally do because we're dependent on the rest of the government to do what we do." So even those who are going to work are kind of stalled. So, there's a whole lot going on. The one positive—and it's not really a positive to make up for the negatives—is that the traffic's a lot lighter here in Washington. But still, not enough to make up for it. Now, I do want to talk a bit about another big topic that’s come forward. You know that RFK Jr. fired 17 members of the Advisory Committee on Immunization Practices. This is the group that gathers to make recommendations around vaccines and immunizations in general. He fired a lot of them. He put some replacements in—many of whom have been featured in other articles—I won’t drill down into the weeds on some of this, but many of them are more than just anti-vaxxers. They’re suggesting that we’ve mismanaged this as a medical community, and that we’ve not been telling the true scientific story. The new people who’ve been put in place haven’t made any formal recommendations yet. But the most recent one that came out is that there’s even some debate about whether newborns should be given hepatitis vaccines. And that data is very, very tight about how many lives are saved because of vaccines—as they all have been shown. But we’ve forgotten data, and we’re going to have to relearn the lesson going forward. Do you read the front page of the paper or don’t you? In my family, it’s split. My wife only reads the sports section. I read the front section—or at least read the headlines. In the Washington Post editorial page was an article written by the last six Surgeon Generals—right and left—appointed by different presidents over time. And this was a very thoughtful piece that basically summarized that RFK Jr.—he’s perfectly entitled to have his own opinions about things—but he’s not entitled (this was their conclusion) to put other people’s health at risk. And they collaboratively, collectively, emphatically said that that is what is going on with this new ACIP committee—with RFK Jr. at the helm. That we are putting a lot of people at risk, and it’s what’s making us all very, very anxious in the medical community today. Now, I want to talk in closing on this about a book that I am reading. Don’t worry, it’s not too boring. And the stuff I’ve been seeing during Jeopardy—I always measure the pulse of America by what ads run during Jeopardy every night. Now, the book I’m reading is brilliant. It’s called Empire of Pain. It’s written by a guy named Patrick Radden Keefe, and it’s the story of the Sacklers, Purdue Pharma, and OxyContin. I’m sure you may have seen the movie about this. It’s brilliantly written, and it starts with the first advertising that was ever done for drugs. This was Librium and Valium—done by Pfizer at the time. And the Sacklers kind of invented this strategy where they were figuring out how to tell a story of a new medicine—in this case, anti-anxiety, kind of anti-depression medicines, Librium and Valium. These were for patients who weren’t psychotic—so they didn’t need to be admitted for their psychiatric anxiety and problems—but there were a lot of people out there who could use a little something to help take the edge off. So, they created a market. They had drugs that would solve this problem for people. And Librium and Valium became the biggest-selling drugs at their time. This was through peer-to-peer teaching. So, start thinking about your own role in this as you listen. Physicians who were trained to teach other physicians about the new medicine. Direct-to-consumer, certainly. The Sacklers owned a medical journal where they advertised in it and could write editorials about their medicine. They also had consultants that worked for it.  Now, as I’ve been reading this, I’ve been thinking: I play all of these roles. I’m a consultant of pharmaceutical companies. I do peer-to-peer education. I do clinical trials. I write papers for journals. I do video podcasts, for God’s sake. And so, I’m out communicating my bias, my opinions to others—to influence their practice on some level. Not my goal, but it’s certainly a downstream product of influencing their practice. So, this family had figured out a way to take advantage—and coach and train us all—how to use medicines. And this was in the very, very early part of my career. But then what they figured out was how to take pain medicine, believe that the pain medicine would help, make it longer-acting, get a good price for it, sell it, convince us all that we needed to be on it, and increase the utilization of long-acting pain medicines. So, when I was just a fellow and a new faculty member, we were all coached that there is no high enough dose. That all patients need to be on it. That it’s normal to be on these drugs. And in point of fact, it is the right thing for people to be doing. Only now do we recognize that this was really an over-push for these people. I’m just reading the section of the book now where people were abusing it. That they became addicted to it. And it was not really for cancer pain or other things—they were just hooked to the drug. And it took a long time for that to get broken. So early in my career, I was pushing huge doses of this medicine. You were, too. And now there’s nobody I’m giving much more than about 10, 20, 30 BID of long-acting pain medicine. So, we learned our lesson about how we were kind of lied to in this setting. More recently, we have a new point-counterpoint with the government. I’m seeing it from Pfizer. I’m seeing ads today during Jeopardy and other shows like that, where Pfizer is basically reminding us all—as an audience—that vaccines can help. The government is telling us, RFK Jr. is telling us, that vaccines are bad. That we shouldn’t be taking them. That they cause all sorts of trouble in patients, and we shouldn’t be messing with it. But then I’ve got Pfizer doing a very clean ad over here that says, “Don’t forget vaccines.” Let’s look a little bit at the science that’s being referred to. The science back when we were giving long-acting pain medicines, and now when we are making new recommendations by our government. So, back then, they actually didn’t even get formal FDA approval for MS Contin, because morphine was already approved. They just got it. They just started shipping it out. They just started making it and shipping it out. They then got approval for OxyContin—but the guy who approved it at the FDA, believe it or not, a couple of years later, starts to go and work for them outside the FDA. So, there’s a lot of question about whether that was legitimately covered. But the idea was that OxyContin would be less addictive—but they never really showed that, even though they marketed that.  So, the cleaner processes that we’re used to for drug approval were not put in place. And then the claims that could be made about how well these pain medicines worked—anybody could say anything. There wasn’t a lot of supervision around that until it kind of came back to bite them and haunt them. We are, in today’s world, hearing the government, RFK Jr.’s gang, and other people talking abou

    33 min
  7. Oncology Unscripted With John Marshall: Episode 22: ESMO, Efficiency, and Evidence: A Look Ahead at New Data and Important Updates

    10/14/2025

    Oncology Unscripted With John Marshall: Episode 22: ESMO, Efficiency, and Evidence: A Look Ahead at New Data and Important Updates

    [00:00:05] Main Topic  ESMO, Efficiency, and Evidence: New Data, China’s Science Leap, and Leucovorin and Autism  John Marshall, MD: Hey everybody, John Marshall from Oncology Unscripted. There is so much going on right now that we're gonna need a full hour-long show, but we're not gonna do that to you. We still promise short bites here and there of the stuff that's going on, just to make sure you're in the loop. I'm sure you are. But let's start with a little science. And the science we wanna focus on is the upcoming ESMO meeting. We've looked at the leading abstracts that are gonna be presented there, and there's not gonna be a lot of surprises about the content. There's a lot of innovation in precision medicine and immunotherapy and different diseases, and positive randomized trials, and some exciting early-phase clinical trials.  But what I think is worth noting is that a pretty high percentage of the science that's being presented at ESMO actually comes from China—Chinese pharmaceutical companies sponsoring it, China's institutions running the clinical trials. And there's been a lot of discussion about the quality of Chinese data. Just recently, on September 23rd, Scott Gottlieb—who used to be, of course, the head of the FDA—did a very nice opinion piece in The Washington Post about the impact of Chinese drug development. The quality wasn't actually that bad—it was just less expensive. They were able to do clinical research much less expensively than we can here in Western society, if you will. So, it's not so much intellectual innovation—it's efficiency in getting answers out. His whole editorial is about: how do we reshape and reprioritize our own clinical research infrastructure? How does the opportunity of a, I don't know, a world turned upside down in terms of regulatory oversight, et cetera, give us a chance to maybe improve the process, to lower the cost of drug development, so that our innovation—which we really still remain the hub for—can actually be brought forward and not create some sort of global intellectual property war, which he refers to, but more: how do we keep up with the pricing structure and the innovations that are out there? So, I encourage you to not only look through the abstracts from ESMO—because there are some very important positive results from that—but also think a little bit about how we, in different parts of the world, even the playing field around the cost of new drug development. I encourage you to read that Scott Gottlieb Washington Post editorial. One of the big abstracts that will be presented is around MRD ctDNA testing and using that technology as a way to define who should receive adjuvant therapy and who should not. Of course, we are interviewing the lead author on that paper, so stick around for that interview. But we clearly can see that genetic testing may, in fact, have a major impact on making us more efficient on who should get adjuvant therapy and who should not. So, I do clearly think that's the evolution that's going forward. You wanna make sure to keep your finger on the pulse of MRD ctDNA testing in the decision-making process for adjuvant therapy and subsequent treatment. I'm lucky enough to be running a protocol here in the United States looking at MRD positivity in patients with colorectal cancer, and others are doing it in other diseases. One of the ways that could, in fact, make that much less expensive is digital pathology. Because it turns out that a digital image of an H&E slide—and there's some fascinating data around this—can actually predict risk almost as well as genetic testing. So, that's very inexpensive. It takes 20 minutes to scan it in, send it off to the computer, AI reads it back, and gives you a risk factor. So, I do want you to also keep a nose out for digital pathology as an impact. But maybe the most unsettled science that I saw in the last week actually was also in The Washington Post. Now, The Washington Post, in one issue, reported on vaccines killing children, our administration down the street is going to be talking about how evil vaccines are—continuing that discussion that their rising costs are gonna break us in the U.S. Our economy is so built around healthcare that the rising costs are eventually gonna break it. And the risk is that what I'm saying right now might land me in the same boat as Jimmy Kimmel—of getting fired. But you know, last night he was back on again. So maybe that will only be temporary. But the science I wanna talk about is this whole connection between, say, Tylenol—acetaminophen—and autism. And the only reason it says “Tylenol” is that Donald Trump can't say the word “acetaminophen.” And so many people out there are affected with autism over many, many decades—even well before Tylenol/acetaminophen was invented. But what really caught my eye is these smaller studies that have suggested that leucovorin—which is folinic acid, okay? It’s reduced folic acid—was helping in some clinical trials. Now, I wanna remind us all that in the United States, in 1998, our diets began to be enriched with folic acid. They did that because there was very good evidence that if you had enough folic acid in your diet and you were pregnant, that you reduced the risk that the baby would have any neural tube defects. So, our entire country is on folic acid supplementation so that we would have a reduced rate of neural tube defects. And for us—or the administration—to now be saying that we should be giving people leucovorin, which is simply a reduced form of folic acid, to try and treat autism is really wild. To the point where the recommendation came out—even this morning—pushing from the White House up to the FDA to relabel leucovorin. Now, I give a lot of leucovorin. I'm a GI oncologist. So, let me just remind you that when we don’t have leucovorin—remember the plant broke, and so we, for a while, didn’t have leucovorin—if you just took folic acid, if you went down to Costco and bought yourself some folic acid and you took it, your body converts it to folinic acid using dihydrofolate reductase—an enzyme we all know and love, 'cause that’s where methotrexate works. So, we’re on it anyway, right? We’re all supplemented through our diet, but also many people take multivitamins and others. But we’re all on folic acid—so much so to the point that side effects from 5-FU in the United States are different than 5-FU side effects in other parts of the world because we're all on low-dose leucovorin, if you will. And so, before we all go crazy—and I know, if you are the parent of somebody with autism or you know somebody, you're tempted to say, “Well, let’s go out. Let’s take some folic acid”—I don't think there's any harm in that. But I think for our administration to change a label based on this amount of data is unprecedented. And I'm anxious about that because it meets a cause that they care about, but you know, it may be influencing how we develop drugs in the future. So, it's science. Yes. Is it early? Yes. Would I like it to be true? Yes. I think we ought to study it further. Should we change a label? I think that’s taking the step too far. So, a lot of science—whether it’s ESMO or in The Washington Post—a lot to learn as we go forward. Pay attention. Value the data that you see in front of you. Qualify it in a way that makes sense to you. And then make your recommendations to your patients and your friends based on that. I think we’ll be better off if we stick to traditional scientific method. Yes, accelerate it. Yes, make it more efficient. But we need traditional scientific method in order to improve outcomes for our patients around the world. John Marshall, Oncology Unscripted. [00:09:11] MedBuzz How Are You Holding Up? John Marshall, MD: Last Monday, I was walking around the hospital and I noticed a different mood. The hospital, in today’s world, has been kind of a safe haven. Whether you're reading the world that’s changing every day and all the rules are thrown out—in the hospital, we all had a common enemy. We had a common purpose. And so, it’s not a political place at all. We were holding doors for each other, we were smiling and encouraging each other—whether you were a patient, whether you were administrative staff or medical staff, whatever—you were part of a team that was working together. But this last Monday, I was walking around, and it really felt different. It felt like people were flat. It felt like people were withdrawn. It was no longer that safe space that we wanted it to be, and I was very anxious about the mood creeping in. The mood that's out there in the world today, about all the changes, was creeping into the hospital itself. It got a little lighter through the week, but I still think it’s a different place. I think it's because of the stuff that’s out there.  Now recently—just last weekend—I was down giving a lecture to the International Society of GI Oncology, a group I helped found many years ago, and I was honored to be given the chance to give a talk at this group. It was an overview of where we are in GI cancers in general. I was thinking about and talking about our jobs, and the work we do, and the pressures that outside is applying, and the emotional connection we have with our patients and with each other, quite honestly, as a team. And I don't often do this, but all of a sudden, my throat got a little caught. I was… I was sad. A loss for words. Anxious for those around us. I'm an old guy—I can survive. But I was worried about the 30- and 40-year-olds that were in the room, that needed to carry the torch forward. I was worried about just all of those pressures that were around. And for the first time, maybe ever, I was struck by the emotion of the time. And it sort of went along with the mood of the hospital. I'm hoping that we can kind of come out of it. I do

    33 min
  8. Oncology Unscripted With John Marshall: Episode 21: Watching Vaccine Access Collapse in Real Time

    09/16/2025

    Oncology Unscripted With John Marshall: Episode 21: Watching Vaccine Access Collapse in Real Time

    [00:00:05] MedBuzz: Back to Being ‘Just a Doctor’ John Marshall, MD: John Marshall for Oncology Unscripted, coming to you live from this big office. This is the biggest office because, you know, I've been the Chief of the Division here at Georgetown for 20 years. I didn't want the job when I was first offered it a long time ago. I ended up saying yes. Of course, that's a dramatic change in one's academic career—taking on administrative roles like this. You do get the big office, which is nice, but you also get a lot of other stuff. You know too much. You know who's mad at whom, you know who you need to recruit, and who you need to un-recruit—all of those things. You have the business side of a cancer business going on, and you're a doctor, and you're doing clinical research, and you're trying to educate everybody around you. About a year or so ago, I decided in my own head that 20 years is enough. And so, as of this summer, I have officially stepped down as the Chief of the Division here at Georgetown. My colleague and much smarter friend, Dr. Steven Liu—lung cancer expert, world expert—is stepping in to be the Chief of our Division, and he's already hit the ground running. The fresh voice is honestly already a positive. You can just hear the freshness of his voice and his attitude and his energy.  You know, the Mayo Clinic actually has a structure where you can only be in a leadership position for so many years, and it has to turn over. And I really like that. It's sort of like what we hope our presidential terms will be. But who knows—that may change. But there's a limit: you do the job for a certain period of time, and then someone else steps in and gives you that fresh voice and fresh perspective. But that's not the traditional way of doing it. Most of the time, people hold on to their position as long as they can hold on to it, until they can't do it anymore or they decide to go to some other institution. But the reason I'm sharing this is that I'm now in this sort of weird new place. I'm an ordinary staff physician. All of a sudden—yep. I have my patients, I'm doing my thing, I'm putting people on clinical trials, I'm educating the brand-new fellows who just showed up here about a month ago. Great fun having brand-new fellows 'cause they don't even know how to spell 5-FU, much less how well it works, how it works, and the side effects, etc. So, I love the first few months 'cause you're teaching people a lot of new things that they need to know. But anyway, that part's very exciting. So, I'm still doing all of that. But what I'm gonna have to get used to is not knowing everything—also not feeling responsible for everything. And that's gonna be a change for me. So, any of you out there who've either been through that transition or who maybe wanna offer me some therapy—I'm in line for some therapy as I transition, as I begin to slow down my academic career, withdrawing as the Chief of the Division, but still doing my day-to-day job and still trying to cure cancer. Take care of each other out there. Take care of your bosses and those leaders. It's not a great, fun job. But also, remember: those of us who are now back in the trenches—we need to take care of each other as well. John Marshall for Oncology Unscripted. [00:03:35] Editorial: Watching Vaccine Access Collapse In Real Time John Marshall, MD: John Marshall Oncology Unscripted. First piece of advice: don’t read the newspaper. Second piece of advice: don’t watch C-SPAN, for sure. Just yesterday on C-SPAN was the big congressional hearings. I did read the summary of it in The Washington Post, where RFK Jr. was interviewed—cross-examined for three hours by both sides of the aisle—about what he has been doing with the CDC. And I think we all, as medical professionals, need to take a big step back and a pause and sort of ask: what the hell is going on? You know, the specifics first. He fired everybody at the CDC. He has hired new people at the CDC. They have not come forward with any formal vaccine recommendations. This is all about vaccines and the like. Yesterday in clinic, a patient of mine—who would be a candidate for both flu and COVID vaccines, who could have, a month ago, walked into CVS and gotten both of those injections—now, in the state of Virginia (and I think there are about 14 other states where this is true), has to have a prescription. This came out from CVS and Walgreens—that you have to write a prescription. Physicians have to write a prescription so that patients can take it to the CVS and Walgreens to get their vaccines. Some states are not providing them at all. Some states have gone the other way, where they’ve formed collaborations—and this is those cool West Coast states: Washington, Oregon, Hawaii, California. They’ve formed a consortium to say, “We are gonna set our own policy,” because the government’s policy right now is up in the air about whether you can get access to them, whether we should be providing them. How do you get access to them? And so we’re all up in the air about what's going to happen. And then, of course, our brilliant RFK Jr.—who, by the way, doesn’t live very far from where I’m sitting right now. There was one day I was walking through Georgetown and crossed paths with him. I was like, “Ugh.” But anyway, he doesn’t live very far from here. But he’s saying that we should kind of get rid of vaccines in general—not just COVID vaccines, but vaccines in general. And so there is, coming out from the ACIP, a set of recommendations. And a lot of states—and I live in one, Virginia, which is over that direction—had agreed from the beginning (and I think there are seven—I don’t know, a bunch of states) that they will follow whatever the law is, they will follow whatever the ACIP says. But that was before we got this new group of people who’ve stepped in to oversee this. And so it may be that it undoes things, and we’re gonna need to put new laws in place. We just can’t have this discussion about CDC and vaccines without saying the word “Florida.” So, Florida has a Surgeon General named Joseph Ladapo. And Joseph Ladapo is a physician—MD, PhD, incredibly well-trained. He is a professor at the University of Florida. He trained at Harvard and other really good places, and he is all about public health. That’s his thing—more on the cardiovascular side of things. But during the pandemic, he was an anti-vaxxer then. And now, of course, you all know that Florida is trying to put forward where children no longer have a vaccine requirement to go to school, etc.—that they can undo that. And these are recommendations and laws that have been in place for over 100 years. And he says, “Nope, we’re not gonna do it anymore.” You know, my mother had polio, for goodness’ sakes. Do we want to go back to that sort of world where children are going to be getting these infections that we had solved—pretty much solved—in the past? And so, you know, we’re joking about, you know, who’s gonna want to go to Disney World. Take your children to Disney World if everybody there is unvaccinated. Maybe it’s the alternative. Maybe that’s the place to go get exposed—like you remember when we were kids? We used to be told to go over and play with the kid who has chickenpox so that we would all get chickenpox. Well, maybe we’ll all just go to Florida so we all get measles, mumps, rubella, and polio—and other things like that. So, who knows how this well-trained person has got it in his mind that this RFK Jr. sort of “vaccines are evil” is part of his mantra, and he’s applying this across the state of Florida. So, I am so anxious about this because I think the next step is access to medical care in general. Right? We know that there are major cuts to Medicaid about to happen—influencing the shutting down of hospitals. Even in the state of Virginia, if we apply the current Medicaid cut recommendations that the new big bill signed, seven rural hospitals will have to close. Those people will not have access to hospitals in their area. Right? Also talking about reducing Medicare support. So, okay, fine—we're gonna reduce the amount of healthcare that’s available to people out there. But what about medicines? What’s lifesaving, and what is a hoax that causes autism? Right now, the CDC and RFK think that vaccines are a hoax that cause autism. Okay, what about immunotherapy for MSI-high patients, right? Is that a hoax, or is that amazing, life-saving therapy? And so we’re splicing and dicing all of these things to the point where we’re not gonna have access to things that we know help broad populations avoid bad infections and death. When is that gonna start to trickle down to other healthcare access, and who’s going to be making those decisions? I think about the HPV vaccine. Right? This is available to both boys and girls. We think—we’re pretty sure—that if everybody were to get this, cervical cancer, head and neck cancers, and others would diminish dramatically because so many of them are caused by HPV infections. Are we gonna do away with those? That’s, in essence, a cancer vaccine—a prevention-of-cancer vaccine. Is that next on the chopping block? So that now our incredible discoveries of the linkage between HPV and cancer are undone—because we can’t prevent it anymore? So, I am very unsettled. The people around us in healthcare are very unsettled. Pharmaceutical industry is very unsettled. Healthcare providers—small hospitals, rural hospitals—are very unsettled. Yet we are being led by people who do not represent the population, who do not represent the 80–90% majority of parents that want their children to have vaccines. What these people are representing are the 5–10% of people who are convinced that vaccines don’t do anything and are crazy to give. And so we need to figure out how to push back

    20 min
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