On a new podcast, VCU’s Winn and City of Hope’s Carpten discuss the mission—and the future—of cancer centers

Is the Community Outreach and Engagement mandate the next item on the chopping block as the Trump administration makes its mark on science policy? What about health disparities research?

“If we got rid of Outreach and Engagement, I think it would be almost like losing a major foundational aspect of a cancer center,” Robert A. Winn, the director at Virginia Commonwealth University Massey Comprehensive Cancer Center, said on The Cancer Letter’s new podcast. “And I think it would make us vulnerable, particularly in the public’s eye in saying, ‘Well, what do you exist for if it’s not for our benefit?’”

On the inaugural episode of The Directors, a series on The Cancer Letter Podcast, we asked Winn, a pulmonologist who holds the Lipman Chair in Oncology at VCU, and John Carpten, the chief scientific officer and director of City of Hope Comprehensive Cancer Center, and director of Beckman Research Institute, to imagine the future of the cancer centers without COE.

If we got rid of Outreach and Engagement, I think it would be almost like losing a major foundational aspect of a cancer center. And I think it would make us vulnerable, particularly in the public’s eye in saying, ‘Well, what do you exist for if it’s not for our benefit?’

Robert A. Winn

“We’ll lose our identity. It’s becoming our identity. And we’d lose it,” concurred Carpten, who holds the Irell & Manella Cancer Center Director’s Distinguished Chair at City of Hope and the Morgan & Helen Chu Director’s Chair of the Beckman Research Institute. “A tragedy. And I’ll just be honest, if that happens I would feel like I would have contributed to it and would be in part to blame, because we have to fight for this.

“It’s at the core of who we are supposed to be as a cancer center,” Carpten said.

“And so, I’m looking forward to standing shoulder to shoulder with Dr. Winn and the other cancer center directors to ensure that the engagement and involvement between the cancer centers and our communities has to be central to who we are and what we do.”

The Directors is a monthly series of interviews focused on the problems that keep directors of cancer centers up at night. The series begins during Black History Month, with Winn and Carpten who are members of an elite—and growing—cohort of Black directors of cancer centers. 

On the national level, Carpten, a genetics and genomics researcher, is the chair of the National Cancer Advisory Board and Winn is the president of the Association of American Cancer Institutes. Also, during Black History Month, Winn serves as the guest editor of this publication.

The first episode features two discussants:

• Norman A. Sharpless, former director of NCI and former acting FDA commissioner, who is now a professor of Cancer Policy and Innovation at UNC-Chapel Hill, and 

• Beverly Ginsburg Cooper, managing director for research at Huron Consulting Group, where she consults with cancer centers as they work to meet NCI designation guidelines while serving their communities.

This episode is sponsored by the American Society of Clinical Oncology. ASCO plays no role in the editorial direction of this podcast.

The Cancer Letter Podcast launches today with three episodes.

Community Outreach and Engagement is shaped by every cancer center’s catchment area, and the purpose of COE is to translate science into health interventions. 

Cancer centers don’t get to choose the populations they serve. 

In some areas, the underserved are largely Hispanic. In others, they are largely Black. And data show that the single largest number of the underserved identify as white. 

“We have many cancer centers, and we all serve many very different communities,” said Carpten. “And we can’t all have one recipe and expect that we’re going to be able to serve every community with that one recipe. So, we have to have that in that engagement and interaction with the community to understand the needs.

“Dr. Winn talked about the data, the catchment data. Who are the individuals? What is your population? The rural? The more urban? The various demographics? Who are the individuals and how are various cancers impacting these different groups? The cancer burden? And without that knowledge, that community health assessment, you don’t know what kind of research is going to truly impact that community.

“So, we have to have COE. It has to continue to move forward.”

Erosion of public trust?

Arguably it’s a sign of the times that directors of cancer centers worry about the erosion of public trust and science.

Said Winn: 

And what are the concerns that keep Carpten up at night?

Cancer centers will continue to “adapt, adopt, and innovate” 

Commenting on the discussion, former NCI director Sharpless said he, too, has heard concerns about the future of COE.

Said Sharpless:

Huron’s Ginsburg Cooper said the mood among cancer center leadership is akin to the stages of grief–which, she points out, lead to acceptance and, eventually, thriving.

Said Ginsburg Cooper:

This podcast is available exclusively on The Cancer Letter Podcast—on Spotify, Apple Podcasts, or Youtube.

A transcript of the podcast is available below:

Paul Goldberg: We are in the midst of a very challenging time in America—also a challenging time in oncology.

So, now, in February 2025, as you chart the course for your institutions, literally making decisions that have impact on thousands of people, what keeps you up at nights?

Rob Winn: John, I’ll let you take that first.

John Carpten: Well, you know, Paul—just trying to ensure that we deliver, regardless of what’s going on; right? There’s a mission. So, do we have everything that we need to serve our patients and the individuals within our catchment area? Do we have the resources, the infrastructure, the capacity, the engagement, the involvement, and the voice of our community? Are we focused?

And, I guess, the overall environment is undergoing a seismic shift. So, are our trainees prepared for what’s coming? Will some of what we do continue the status quo? Of course, probably, but there are major shifts afoot: funding levels, what’s fundable, things like indirects.

There are a lot of things happening on a national stage that can impact and shift how we do business, but ultimately, we do business. So, there’s just a lot of uncertainty right now, any day or any hour during the day.

Something could change, but ultimately, we have to deliver.

And so, that’s what keeps me up at night, ensuring that we have everything that we need to deliver for our patients and the people within our catchment area, and cancer patients everywhere.

That’s what the expectation is for the City of Hope, and that’s what I will continue to focus on.

Paul Goldberg: Dr. Winn, are you sleeping well?

Rob Winn: I wish. But I think that the biggest focus for us is doing better science to help more people. 

That’s my focus.

So, what keeps me up at night—it turns out that, certainly in the NIH budget, the NCI budget, are things that we have to deal with, and we have to navigate.

It also turns out that we have to make sure that our young investigators remain enthusiastic and that we have the resources to allow them to continue to do the science that will impact not just today, but tomorrow.

The one thing that keeps me up at night, believe it or not, is the issue around public trust.

As we are creating better science, which we are, as we are creating better technologies, and I hope that doesn’t stop, because we’ve done over the last 50 years, we have not only impacted the health of the United States by reducing the burden of cancer by over 25% for everybody, but, listen, we have impacted the global world.

When you think of some of the most impactful discoveries that have happened, it’s been out of the NCI and our academic medical centers in the United States.

But what keeps me awake is the fact that we may, throughout all progress, be disconnected in a way in which we lose public trust. We lose that public trust that actually will also be an additional headwind that will prevent the science from doing what I want to do, which is to have better science that actually impacts more people.

I wish I could talk only about the science, but it is about the science.

John knows that it’s about everything from the basic science, fundamental science that drives translation of that science into creating new molecules that become medicines.

But at the end of the day, the reality is, you can have the best medicines, but if you don’t have public trust, you don’t have everything. And that’s what we’re building here at Massey, to make sure that we make the science more transparent, make the science more accessible, and make the science more connected to the people we serve.

Paul Goldberg: I’m not really convinced that the public trust is lost. It’s lost among some folks, but not others.

John Carpten: I don’t even know if it’s about it being lost—sorry, for interrupting—I think for some groups, it was never there in the first place. So, Rob, I’ll let you continue to answer. That was just my point.

Rob Winn: John, I think that was spot-on.

I was about to say that we are in an era now—with Dr. TikTok and Dr. Google, where you now have people that are challenging the science, I believe we do have more fragmentation of what’s the difference between 1950, 1960, 1970, when there was a sense of momentum.

We’re just in a different era, we actually have to work harder. be more transparent, work at communicating, and at making sure that the science is understandable, or at least accessible to more people.

Paul Goldberg: The role of a cancer center director is actually more roles than I can count. But one of them has to be that of a public intellectual, and that’s why we are doing this—that’s why we started The Directors.

Joe Simone, who was a wise man, whom you might describe as the Will Rogers of cancer centers, wrote a collection of maxims that I keep on my desk, and many others do as well.

One of his maxims is “Leadership does matter.”

What is it like to be a leader of a cancer center right now? How are you communicating with your faculty, the staff, the patients who are surely worried?

John Carpten: There’s the old saying: “Never waste a good challenging situation.”

We just went through one in Southern California—with the wildfires.

And it’s interesting how you learn a lot about who you are.

When the system is stressed, and the system is being stressed right now, you can either cut and run from it, or you can face it and learn from these challenges so that we’ll be better in the future than we are today.

I think the role of a cancer center director is changing, and I think it will continue to change over the course of the next three to seven years, and those who learn from the mistakes, learn from the challenges, learn how to continue to be effective in impacting our communities are the cancer center directors—and the cancer centers themselves—that will continue to advance and have incredible impact on not just our catchment areas, but the world as a whole.

Rob Winn: I think once upon a time you looked at a cancer center director and what you saw was one flavor.

It was somebody that maybe understood basic science, and maybe kind of cared about translational.

You now have cancer center directors that represent the most basic in basic. We now have cancer center directors who really understand the data sciences and how we’re going to use large language systems for better science to actually do better care.

But you also have people who are actually cancer-control-minded.

In the early seventies, I would say, mostly cancer center directors, probably most of them, had a type.

In 2025, as opposed to 1975, I think we’re talking about a broader group of types of cancer center directors, which means there’s a potential broader impact for America as a result of bringing people who are very much focused on cancer control issues, others who are focused on the bridging of the cancer control issues to the data, and how that is driven by the fundamental scientists.

I just think that as a group of these 72 cancer center directors that we are coming probably at the best time for us in the context of the diversity of thought, and also the diversity of disciplines to better serve the NCI and the American public.

So, I’m excited about this.

John Carpten: A lot of diverse input. And that tends to lead to innovation. And we are in a time where we need to innovate.

Paul Goldberg: But I guess my question is how do you get the American people to understand the scientific method and to realize that it’s actually important to them, as opposed to magical thinking, or God knows what—political thinking?

Rob Winn: When I came in January of 2020 to be the cancer center director here at Massey, we had one goal: let’s try to become a Comprehensive Cancer Center.

I actually told them that that wasn’t my goal. The goal was to actually—Number One—be able to have more people understand why the science matters.

And as you talked about the science methodology, I’m going to reframe that, so it says, the benefit of scientific thinking, and the impact it has on them.

Part of this was related to our ability to engage our scientific community and bridge that gap with our community. There is a science, believe it or not, of communicating. There is a science of engagement that is an emerging science that has been over the last 30, 40 years.

And so, we have taken seriously the art of bringing people into the cancer center, but also having folks go out from the cancer center to engage with various community members to—one—show that we don’t just show up for one special fair and never show up again.

There is a consistent sense that we are going to be there, and therefore it opens up minds, and they listen.

We’ve also had to go to social media, become much more sophisticated at reaching people where they are.

I don’t know what cancer center these days doesn’t have a social media platform.

So, Paul, to address your question directly, I think that I now have people who would never have paid much attention to the cancer center come up to me and say, “Dr. Winn, I’ve just told somebody about Massey.”

And I said, “Well, what did you tell him?”

“I told him, Massey’s a different kind of cancer center, because y’all care for everybody. In fact, no one had ever been in my little town of Bath, and now, all of a sudden, your cancer guy showed up, and then you took care of my aunt.”

So, we make it feel as if it’s actually also personal—the connectedness, right, to the community.

We are now generating personalized data for each of these communities, so that they know their cancer health, like almost a cancer report card.

Working with the community that way, and unpacking the science and letting them know that immunotherapy just didn’t fall from the sky, that there were hardworking people, that even when the lights weren’t on and the cameras weren’t shown, that were still doing the work has now resulted in their aunt having a fighting, chance of having an extended life.

John Carpten: I totally agree. It’s the process of making science more understandable—period.

Reflecting back on some of the earlier comments about what the cancer center was back in the early to mid-seventies versus what it is now, back then, the communication was more insular. And it was within the cancer center and out to the scientific community.

Now, the communication is more outward, as we think about the age of Community Outreach and Engagement as a required component of the Comprehensive Cancer Center system and network.

There’s been a lot of work to help us develop best practices on how we engage and involve the community. And then, that bidirectional communication helps us both communicate better and helps us understand, because it’s not just the community understanding the scientific method—it’s also us understanding the needs of the community, and not just the Community Outreach and Engagement specialists, but the scientists themselves. 

And I think we’ve made tons of progress.

I still think we’ve got a long way to go to get there, but I think about new innovations—with AI, large language models, natural language processing—and the opportunities we have to innovate and use the information in these best practices to get even better at that bidirectional communication.

And I really do think that it’s that bidirectional communication that’s more important than just us teaching the community about the scientific method and the importance of the work we do. 

We need to understand the community’s needs as well.

Paul Goldberg: Well, here’s what I’m losing sleep over. I’m really worried that some folks in Washington might misunderstand the meaning of Community Outreach and Engagement, what it is, what it does.

It’s a requirement for designation of the cancer centers. So why is it there? And maybe, as a thought experiment, can you imagine life without it?

John Carpten: No.

Rob Winn: To many of my colleagues, we would actually put the old adage—”It’s all about the science, baby.”

And it is true.

But in an era where we have much more of a populous society that ultimately is also wondering what it is that we are doing, we run the risk by not actually engaging the community, of having the tag “elite institution” placed on us, and therefore the mistrust, the distrust, the low trust.

The one thing that we were brilliant at, and I’m gonna say this to Bob Croyle back in the day, shout out to Henry Ciolino and whomever were involved with that—to Electra Paskett, Bob Hiatt. They said, “You know what would make sense? Who are you serving?

By having a community outreach and engagement, here are three pillars within that:

One, defining the data of a catchment area, that is 85% or more of the people whom you serve. By then, you can now actually have a mechanism that says, do you know what value we actually have?

Not only do we serve this area, but let me show you what we have done as a result of screening, as a result of educating, and a result of getting more people from that area onto clinical trials.

Because at the end of the day, we understand that our job is to serve you.

Without an Outreach and Engagement component, who, from our rural areas, just picking on them for a second, would actually give two hoots about the science that’s being generated if it doesn’t impact them?

Outreach and engagement, by the way, should be one of the core components, along with the science, not instead of, not above, but along with the emphasis on the fundamental sciences and translational sciences is the science of how then do we get the dissemination and the implementation of this stuff out in the community.

And the science of engagement is the secret sauce of saying, “This is the value we have for you.”

John Carpten: I totally agree. And I think the whole concept of variety is the spice of life. We have many cancer centers, and we all serve many very different communities.

And we can’t all have one recipe and expect that we’re going to be able to serve every community with that one recipe.

So, we have to have that in that engagement and interaction with the community to understand the needs.

Dr. Winn talked about the data, the catchment data. Who are the individuals? What is your population? The rural? The more urban? The various demographics? Who are the individuals and how are various cancers impacting these different groups? The cancer burden?

And without that knowledge, that community health assessment, you don’t know what kind of research is going to truly impact that community.

So, we have to have COE. It has to continue to move forward.

Rob Winn: Along with the DNA, it’s that ZNA, man—that ZIP Code-neighborhood association—is important.

John Carpten: Absolutely. Every community is different.

Paul Goldberg: Plus you do not set the catchment area. COE is determined by the catchment area, and you have absolutely no control over who is there. That was decided through migrations.

Rob Winn: If I wound up being the cancer center director of Utah, then I’d serve the population that I have in Utah.

What I love about the brilliance of the NCI, the brilliance of 20 some odd years ago, of having a catchment area that a cancer center is responsible for, and to be measured on, and to be evaluated on, is how well do you serve that catchment? How does the science impact the community?

And that is something that’s different for the NCI-designated cancer centers.

That’s different than any other program in the country.

John Carpten: That’s right.

Paul Goldberg: Otis Brawley, our friend, has data that basically shows—I don’t have it in front of me, but there is a paper where he shows that the most underserved group in the United States is white.

Rob Winn: So, I will say to Otis that he is making a good point that we don’t always make, when you think of the volume of people, it’s still the majority white in this country.

John Carpten: The volume…

Rob Winn: But when you think of where most of the people are living, they’re not always living in densely populated cities.

When I think of, for example, a 70-year-old white male that lives in Beattyville, Kentucky, we know that their outcomes are three times worse when it comes to cancer than a 17-year-old white man that’s living in Salt Lake City, Utah.

Why?

Because place and space matter. So, he’s correct. When we look at the health of white women or poor people, right? Because it’s not just being white, it’s also what you have access to. That’s why the ZNA matters, right? We are talking about people who don’t have access always to the best insurances, or the best actual infrastructures for care.

Those are not just people of color. This is why, when we talk about this issue around disparities—I’m gonna use that word “disparities”—is it just synonymous with African American? 

I don’t even know why. 

No!

When we talk about disparities globally, we’re looking at places like Barbourville, Kentucky. We are looking at places like Louisiana. We are looking at places like Arkansas and West Virginia.

And we understand that the burden of cancer in many of those communities, some of those communities are predominantly white, are doing less well. We also want to not make the mistake that the rule is only white.

John Carpten: That’s right.

Rob Winn: There has been an intersectionality of people, both the general African Americans, all across the country.

So, what I’m saying to you, Paul, is that I absolutely agree with Dr. Brawley, that we need to look at a broader swath and understand that the promise of 1971 was that we would eradicate cancer by 1981.

Now, that hasn’t happened. But what we can do is it says, this is an opportunity with AI, machine learning and other innovative technologies around the scientific engagement of how do we push the science—better science to help more people. And that’s our goal.

John Carpten: I think, from a purely volume perspective, he’s right. When you think about burden and you think about rates by group, you can clearly see that the burdens of certain cancers do track differently.

So, we have to keep both of those things in perspective. And I agree with Dr. Winn, when you think about rural communities, it’s very diverse—those are diverse geographies.

We also have our federally designated lands. We have rural areas, the Mississippi Delta, which is my home, and which has a very large African American community, very rural, very underserved.

And there are areas in the heartland of the country that are also very rural and very white.

The point is, cancer does not discriminate.

Everyone needs access to innovations to improve outcomes for cancer. And I think that that’s the type of work that we all need to continue to do.

Rob Winn: John, thank you for saying that. You know, I love what you said, cancer doesn’t discriminate and neither can your leaders of cancer centers. We take care of cancer.

That’s what we take care of—everyone.

Paul Goldberg: And that’s interesting, because both of you do lab research as well as public health interventions.

What are the possibilities you see now going really from the markers for say, prostate cancer up and on to through public health measures? Where is the science now? How do you go do the work that both of you’re famous for?

John Carpten: I do need you to rephrase that question, Paul, please. Rephrase it for me. I’m trying to understand.

Paul Goldberg: I’m thinking about your landmark work on the markers for prostate cancer, for example. How do you go from there as a cancer center director? You can go from there to actual population experiments.

John Carpten: It’s a really great question, Paul, because I think it speaks to a couple of different things.

You’re getting at how do we advance that research to impact public health through policy.

But I think it also touches on something else that reflects back on the previous conversation we had about Dr. Brawley’s perspective, and that there’s disease prevalence and what can we do to reduce the actual prevalence—the risk.

How can we assess risk? And then there’s outcomes, which is the patient has already been diagnosed with cancer. Maybe it’s advanced cancer. So, how do we impact and try to improve their outcomes?

I think sometimes we lump disparities into one bucket and say, oh, it’s all socioeconomics.

Well, sometimes socioeconomics may not be the key factor that’s driving an increase in incidence.

That could be genetic and biological. However, the outcomes, who can get access to the best medicines and the best surgical approaches, that could actually be access.

So, we have to keep both of those things in perspective.

But circling back to your question, Paul, how do we move those things—policy changes with evidence—we need to collect the appropriate evidence, and data to allow us to show, for instance, [using] the example of prostate cancer: We know that there are a series of genetic markers and risk factors that are associated with an increased risk for prostate cancer. 

And over the course of, let’s say the last 10 to 12 years, a number of individuals have begun to refine that group of genetic variants to develop what we call the polygenic risk score.

We’re going to take a series of variants, we’re going to measure those variants and see how many of those risk variants do you have, that genetic load of sorts, how does that associate with an increase in risk?

And so, there are a number of large studies that have been done, and, importantly, they’ve been done in various cohorts: white cohorts, African American cohorts, Hispanic/Latino cohorts, to understand what is the right collection of variants that’s going to have a performance that’s equal across all populations.

And that’s the work that’s ongoing.

Now, I think one of the things that has challenged some of this work are the sizes of the cohorts.

And there was a time where there was a lot of funding going into the creation and building of cohorts. 

And over the course of the last, let’s say 15 years, the amount of funding for the development of those cohorts has retracted a bit. So, I think we’re coming back to that stage where prevention and early detection are beginning to take a bit of the lead, and I’m excited about it.

And so, hopefully, we’ll see the creation of larger, more diverse cohorts.

We can collect the appropriate data, validate the findings, and have access to a really high-performance polygenic risk score that will tell us which men are at risk for developing prostate cancer—one, and hopefully—two—which men are at high risk of developing a more aggressive form of prostate cancer.

And then we can not only just determine a man’s likely predisposition to prostate cancer, but also how do we manage that individual over time? Do we take more of a watchful waiting approach, or do we take a more aggressive approach to treatment?

So, I think that that’s where the field is heading right now, Paul. We’re trying to validate the polygenic risk scores and make sure that they perform across populations, and that they can actually provide at least some level of information on likely disease trajectory.

Rob Winn: And what I love about what you just said, John, is that this is my everyday excitement about being a cancer center director. And it is true. I love RNA-binding protein, and protein methylation.

But my role as a cancer center director is the following: To continue to add to the conversation and knowledge of fundamental science to actually continue to add to the translational sciences.

And, Paul, you know, the immunotherapy, the discoveries within that, the molecular targeted therapy, the advent of thinking about vaccines as new treatments for cancer—it’s exciting.

But then you have the data, and I think John alluded to this earlier, even when we’re starting to think about the polygenic risk scores, we’re actually talking about both genetic genomic data, but we are also now talking about data from places like where you live.

Which is why we need the backbone of the AI and the large language model systems.

And, finally, when it comes to the public health stuff with cancer control, again, the backbone of the data, the cohorts, the AI, the machine learning, we are at one of the most exciting times of science, which is why I hope everyone, no matter what persuasion they’re from, understands that we have made an impact reducing cancer around the United States and the world.

And the world has much more to gain, because we have not just even gotten out of first gear yet with the data scientists, with some of the other things that we have with the advent of even some of the basic scientists, we are not even close yet to getting out of first gear to what we, that science will be able to have an impact on human beings and making the C-word smaller.

John Carpten: And just one last comment, and I think that this also reflects back on our conversations about COE and importance as we create these novel approaches for early detection and these risk models that we can communicate that effectively to our communities, because they can not only learn, right, but they can also be the advocates. That they’ll help push this to policy…

Paul Goldberg: But here you are, actually in a position to implement this as a public health measure thanks to the Cancer Centers Program. And very much thanks to the Community Outreach and Engagement, which I’m losing sleep over, because it just might be lost and swept out with whatever changes might be happening.

Rob Winn: That would be a big, huge mistake, by the way.

John Carpten: A tragedy. And I’ll just be honest, if that happens I would feel like I would have contributed to it and would be in part to blame, because we have to fight for this.

It’s at the core of who we are supposed to be as a cancer center.

And so, I’m looking forward to standing shoulder to shoulder with Dr. Winn and the other cancer center directors to ensure that the engagement and involvement between the cancer centers and our communities has to be central to who we are and what we do.

Rob Winn: And, John, can I just add real quick that even if you’re a basic science NCI-designated cancer center, at the end of the day, we are all about applied sciences.

John Carpten: That’s right.

Rob Winn: We need to look at the impact, the cancer center structure, and the CCSG about our impact on policies, our impact on our catchment area gives us a venue like nobody else to say, is your science interesting? But is your science impactful?

We have the only structure within the whole entire NIH that I believe really has over time shown that our research leads to impact. And so, if we got rid of Outreach and Engagement, I think it would be almost like losing a major foundational aspect of a cancer center.

And I think it would make us vulnerable, particularly in the public’s eye in saying, “Well, what do you exist for if it’s not for our benefit?”

John Carpten: We’ll lose our identity. It’s becoming our identity. And we’d lose it.

Paul Goldberg: Since we are staging thought experiments, can you imagine the world without NCI charting the course for cancer research?

What does it look like if NCI is eviscerated, like a number of agencies are now being eviscerated?

Rob Winn: So, Paul, you just described one of the Hollywood movies like Terminator II or something post-apocalyptic.

I mean, come on, man.

What we have right now, and it is true over time, we do have better partnerships with industry. We certainly have better partnerships with, I think the professional groups like ACS, AACR and ASCO.

We certainly have philanthropy and state dollars, but if the NIH were to, and again, we’re talking about this theoretically. Because I don’t think anyone would…

Paul Goldberg: It’s a thought experiment.

Rob Winn: It’s a thought experiment. It was dystopian. Aristotle said, you can entertain without accepting; right? That’s the mark of a smart person; right?

You can entertain that we don’t have an NIH, or we don’t have an NCI. We would be unrecognizable.

The level of science, the quality of science, the quantity of science, the impact of the science would be eviscerated in a way in which you would not even be recognizable as an entity.

So, the thought experiment is, what did we have at the NIH, the NCI, and the funding of it is a major source of oxygen, and actually a major source of why we have actually reduced the Big C to a smaller c—because of the science that’s been driven.

If we were to lose that, you might as well sort of say it’s like losing most of our limbs.

We’d exist, but we wouldn’t be recognizable.

John Carpten: I agree a hundred percent. I guess from my perspective, it’s not a world I would wanna live in, but I do think that there’s a seismic shift afoot.

And it’s an opportunity to rethink. And I think it was Dr. Winn who used the word “reimagine.” What could it look like?

And as we think about the next five years, the next 10 years, how we do science, how we make discoveries, how we develop drugs, how we engage with our communities, how we navigate our patients could be very different then than it is now.

So, the cancer center network has an opportunity to begin to refresh and rethink an innovative path forward to what the NCI and what the national cancer center network looks like.

Paul Goldberg: But do you survive? It might have an ability to survive, even if NCI is gutted.

Rob Winn: We would figure out a way, but it would be very different.

John Carpten: Yes.

Rob Winn: We would figure out a way, but it certainly would not be where we are now. And it would take us a long time to probably even figure out how to get back to where we are now if we work at it

So, I hope that a postapocalyptic dream that you just gave, I hope, never materializes. I hope it’s only the stuff of Hollywood.

John Carpten: So, what do we see the first 50 years? Was it 25% decrease in mortality rates?

And then, President Biden’s challenge to reduce by 50% in 25 years. That requires a little bit of a shift and a difference in how we do things. And I’m excited about that.

Rob Winn: Me too.

Paul Goldberg: Well, we just need a very strong NCI director who is able to express those dreams to the new administration.

Rob Winn: Absolutely. That becomes a very critical position for us. I’ll say that we’ve had some really amazing people prior in that position who’ve defended us incredibly well and articulated what we needed.

Certainly, at this point, having someone that understands the role of cancer centers, designated cancer centers in particular, is going to be, obviously, important for the success of all of us in contributing to how better science makes for better people and healthier people.

I hope whoever that is, that they, and I’m almost certain whoever that is, they will understand the importance of the role of cancer centers and their research and their portfolio and their impact across the country.

Paul Goldberg: Absolutely. It’s crucial. Is there anything that I forgot to ask? Anything we didn’t cover?

Rob Winn: I was just going to say within this 50 years since 1971, I have been grateful for many of the leaders that have come before us, and particularly people like Harold P. Freeman, and people like…

John Carpten: Lovell Jones.

Rob Winn: Otis Brawley, Lucille Adams-Campbell.

John Carpten: Sanya Springfield…

Rob Winn: John Ruffin…

John Carpten: Paulette Gray…

Rob Winn: Louis Sullivan… So, there have been many…

John Carpten: On the shoulders of giants…

Rob Winn: Come on, man. So, I think that what we hopefully represent is the future of how we’ve done well, but how we can do even better.

And I’m so happy I’m able to share the spot with John, because whether you come from the cancer control perspective or the foundational science perspective, fundamental scientists and basic scientists, we all get to the same point: How do we actually have better science wherever that comes from, to actually create healthier people, to have more impact and better lives. 

That’s all we’re trying to do with all of our cancer centers.

Paul Goldberg: Well, Dr. Carpten, anything else comes to mind?

John Carpten: I’m excited. You know, there was a bit of trepidation at first, but I’m really excited, because I think we’re in an environment that’s gonna force change, and it’s gonna force us to shift, and that’s gonna force us to innovate.

And I love innovation.

And so, I’m really excited about what’s in front of us and again, reflecting on Dr. Winn’s comments about we didn’t get here by ourselves, and, Paul, I’d just like to thank you for recognizing the importance of this being Black History Month and having Dr. Winn and I have the opportunity to share this moment.

We know a lot of people are watching, and neither he nor I got here alone.

There are a lot of individuals out there, but right now’s the time for us to come together. If there was ever a moment to come together and ensure that the cancer center network and the NCI remain strong and remain at the core of improving the lives of cancer patients here in the States and around the world.

Paul Goldberg: Well, thank you so much for being the first guests on The Directors, and also our thanks to ASCO for sponsoring this program.

And now we are joined by Ned Sharpless and Bev Ginsburg Cooper. Ned is a former NCI director and a former acting FDA commissioner. He is now the professor of cancer policy and innovation at UNC Chapel Hill, where he had previously served as the center director. 

And Bev is a managing director for research at Huron Consulting Group. As a consultant, Bev helps cancer centers meet NCI designation guidelines and serve their communities. 

Now, thank you again for joining us. What are your thoughts about what you’ve just heard?

Norman Sharpless: I really enjoyed that conversation from two old friends, Rob Winn, and John Carpten. 

I have to say one, one thing struck me right off-the-bat, and that’s because of the moment we’re living in—with the present set of policies out of the White House that seem aimed in radically reshaping the NIH and the FDA—and it was this interchange they had between the two of them about rebuilding the scientific trust.

I think what we’re seeing is, if we’ve lost the trust or ever had it to begin with, I don’t know. 

But there is this tremendous amount of skepticism right now about the NIH, and it’s really on us, those of us interested in science and the NIH to communicate effectively as to why the NIH and the NCI are such a good use of federal dollars and why they are so important.

And I think it’s great to hear—and nobody can really do that better. 

Perhaps the most useful tool, the group of people to talk to the public about cancer research are cancer center directors. It’s really a powerful thing. 

The NCI has to have these charismatic, thoughtful leaders who can explain why cancer research is so valuable, and why it’s been so useful, and why it affects the lives in a specific community.

Beverly Ginsburg Cooper: Well, it was great to hear two wonderful leaders who have really helped shape where cancer centers are today, and in many ways define the new cancer leadership that will take us through the next several decades.

It is a difficult time for all of our friends in the NCI community. 

And what I would say is we have to pull ourselves up from the bootstraps, recognize that the community that we serve wants something different from us, or hasn’t really understood all that goes into cancer research that result in treatments that they may benefit from today.

But it took 20 years [for modalities] like CAR T-cells, etc., to actually come to fruition.

So, in many ways, if we think about Community Outreach and Engagement, when I got into this field that meant health fairs, and then we went into screenings, and we didn’t really navigate the patient after the diagnosis to get the care that they needed. 

But today, when we think about COE, there’s so much great work that’s being done around the country in outreach, and COE leaders really connecting both with rural as well as urban underserved populations, but perhaps we have not done as well to be as data-driven or to do what I call “inreach,” getting basic scientists and their trainees, translational scientists and their teams out to the community to explain their work and the discoveries that took all of those years. 

And without NIH dollars, without the community support and donor dollars, these great treatments that are saving the lives of their family members, their friends, their community would not occur.

There is nothing like the NCI cancer center community in my experience. And look at all that we’ve done. So, we just have to think about how to do things more smartly.

Norman Sharpless: One other thing that resonated… I like to hear the full-throated defense of COE. 

Beverly Ginsburg Cooper: Yes.

Norman Sharpless: I’ll tell you, I was in a faculty meeting not long ago, as in a week ago, where because of the new executive order around DEI, someone from a public health background had said, “Maybe we can’t study health disparities any longer either. And I was so depressed to hear that.

Beverly Ginsburg Cooper: No.

Norman Sharpless: I was in a faculty meeting not long ago, where, because of the new executive order around DEI [was discussed], and someone from a public health background had said, “Maybe we can’t study health disparities any longer, either.”

And I was so depressed to hear that. That’s a complete misinterpretation of the scientific priorities. And I would say, now is the time, more than ever, [that] we have to explain why understanding what contributes to disparities and outcome within our catchment areas is a crucial question the NCI should be investing in.

And so it’s good to hear John and Rob issue this sort of full-throated endorsement that we have to continue to work on COE. That’s one of the things that the NCI designated Cancer Centers should be doing.

There perhaps were some excesses attributable to DEI, but that is not, shouldn’t reflect what we’re doing scientifically.

Health disparities, whether they’re caused by race, ethnicity, socioeconomic factors, rurality, religion, geography—all those things are appropriate scientific questions [for] NCI.

It’s absurd to me, Paul, because the NCI is required by law to produce a report on minority health and health disparities every year. 

So, the idea that they’re going to lose interest in health disparities is absurd. But I think it’s just a sign of the times we’re living in. People are overreacting and becoming risk-averse.

Paul Goldberg: We should probably distinguish DEI from COE because COE is determined by your catchment area. You don’t choose your catchment area except when you accept the job of director. 

And most of the underserved in the United States, according to some data, would be, actually, white. 

So, in a way, it’s a different subject. 

It’s a three-letter abbreviation.

Beverly Ginsburg Cooper: It’s a three-letter—and you know, people have been sparked by words. 

But if you separate the words of DEI from the work that we’re doing in COE, it’s by the numbers. Where do you have a higher incidence, a higher cancer burden than with other groups? I work with a lot of cancer centers that have very high cancer disparities—but it’s in rural areas.

Norman Sharpless: So, Paul, I think my camera froze, so you couldn’t see me nodding vigorously to what you said, but I think you actually said it better than I did. My point was they have nothing to do with each other.

Beverly Ginsburg Cooper: That’s right.

Norman Sharpless: Other than their three letter acronyms that confuse people. 

But cancer health disparities is an appropriately important question that, of course, we should be studying and, to be put off by that because of an HR topic rather than a scientific topic would be a real mistake. 

But unfortunately, it’s one that I believe is being made consistently across the country right now. So, the cancer centers can provide leadership here and say, “Look, this is something we should be doing and we will do…”

Paul Goldberg: Well, cancer center directors really have so many roles, but one of them is to be a public intellectual. And that is why we started this, this podcast, this program. So, the other question is, can you imagine the world without NCI being the lead of cancer research? 

This was a thought experiment that I proposed that’s kind of dystopian, but knowingly so… What happens?

Norman Sharpless: This is, first of all, it’s not as dystopian a thought experiment as you might think. You know, members of Congress ask this question routinely: “Do we need a federal agency to support science? Is that really the best way to do it?”

And you know, Paul, the history of the United States better than I do, but was it a conscious government decision that perhaps some are wondering, should we revisit? 

And I would argue that the data suggests that the NIH and the NCI are a really good investment. 

If you look at new therapies, new approaches to cancer, new prevention modalities, new diagnostics, they all have a root in NIH-funded and NCI-funded science. And that the activities the NCI and the NIH undertake to help science develop are valuable and effective.

I do think it’s pretty clear that what NIH and NCI do most valuably is a fund  the really early basic science, the so-called curiosity-driven science that may not be as immediately translatable, and that there’s a role for industry to then come in and partner with the NIH to move things into the commercial sphere. 

But I think we’ve figured this out. We have this framework of funding science and funding some basic and translational research through the government and academic sites, and then moving that into privatizing through commercial use as needed. 

And the system definitely works. 

And I think if the NIH were to go away and no one were to pick up that ball and fund very early stage science, then we’d miss it. You can see this in other countries that don’t have anything like the NIH, and I advise these countries—I have advisory roles in Europe and Japan—and they ask, “How can we have an innovation ecosystem like the United States?”

And I say, “Well, you need the NIH to fund $40 billion of research a year, and then it’ll work.”

And so, I think what we would miss it if it were gone, and we’d miss it sooner than we thought, to paraphrase Mitch McConnell there.

Beverly Ginsburg Cooper: If you look at the economic return on investment of just your cancer centers, we’ve seen this time and time again for every NIH dollar that an institution receives, there’s at least $3 in economic return. 

And when you look at the economic impact analysis that centers like Kansas, UAB, Pittsburgh have all published, you’re seeing billions of dollars of return to the economy of states across the country. 

When you look at the technology transfer impact of NIH dollars that then result in patents, licenses, and companies that are started in this country and beyond, the return just economically is really tremendous.

And the other part, Ned, is we’re a training ground; right? For scientists, providers, etc., across the country. 

And I think that message has also been lost,

Paul Goldberg: Now, what’s the mood out there? What do you see? 

Norman Sharpless: Oh, Paul, we don’t have time for that. The mood is scared. 

I would say there’s tremendous fear about changes. You know, there are these sort of announcements of potential draconian cuts in terms of personnel at the NIH and the FDA. 

There’s the uncertainty around indirect costs. There’s the talk from Congress about NIH restructuring—people are really scared. 

I encourage my colleagues not to overreact. 

I think some of this fear is self-driven and feeds on itself and is unwise. 

I’m surprised by how many people do not know the US Constitution grants the executive branch, some things, and the Congress has got the power of the purse, for example. 

So, I encourage everyone to go read Article I and Article II, if they haven’t done that recently.

But I think that the mood is really scared. There’s a lot of uncertainty. 

There’s no doubt we’re in for changes with RFK now being confirmed as the secretary of HHS, and his noted skepticism for some aspects of what the NIH and the FDA have been doing. So, it’s uncertain times. 

But I think the thing that has to be said is there’s a lot of support for the NIH and other parts of HHS in Congress and the American public. And a lot of the value of what the NIH does is well known. 

And I think that if we can stick to the key message, which is that the NIH is really important, it’s valuable, and you’d miss it if we were gone, 

Then, I think that this is also an opportunity to improve some things that the NIH needs to do better.

Beverly Ginsburg Cooper: I’ll just add that when this all first hit, we went from shock to depression.

I think we’re going through the stages of grief, but what was really interesting to me was, in talking to a number of cancer center directors this week, they’re determined that we continue on, we put one foot in front of the other, we continue our great work. 

We may have to change a few things, [like we] can’t say cancer inequities. We need to focus on more metrics-driven outreach activities, etc. 

We need to adjust. But the mission and the drive and the determination remain as strong as I have ever seen it. 

And it was quite remarkable to me. I thought I would’ve heard more of “the sky is falling.”

And what I really heard was, “We’re gonna move on. We’re gonna adapt, we’re gonna adopt, we’re going to innovate.” 

Paul Goldberg: Absolutely. And I should disclose that we did that first part of the interview [was taped] hours before the indirect cost announcement came out, and which is a blessing, because if we had been talking about that at that time, we would’ve been talking about indirect costs, and that would’ve really been a bad thing, because there’s so much to talk about what the cancer centers are.

And, by the way, everything we’re talking about right now is going to be antiquated six hours from now.

Norman Sharpless: Oh yes. No doubt.

Paul Goldberg: It’s just uncertainty of the fast-changing world we live in.

Norman Sharpless: When I became a cancer director, University of North Carolina in 2014, I went to the first NCI…—the NCI convenes a meeting of all the cancer center directors every year in Bethesda, or actually in Gaithersburg. 

And the first meeting I went to, I was welcomed to that fraternity of NCI directors—and at that time, it was largely a fraternity—by Tom Lynch. 

And I was the youngest cancer director by a considerable margin at the time. And I remember saying that kind of whispering to Tom under my breath, “It’s a bunch of old white men.”

And Tom was like, “Yeah.”

And, and now, you know, I mean, we see these two wonderful, charismatic, compelling leaders, John and Rob, who are African American.

There are a couple more, you know, Selwyn Vickers and others. It’s not novel anymore. There’s so many great African American leaders. It’s almost unremarkable, which is remarkable in and of itself. 

So I think, you know, while it’s possible to dwell on the negative sometimes, in terms of diversity within leadership at the NCI, things have gotten a lot better in the last decade. 

And I think that’s worth pointing out. 

And hopefully it will become truly unremarkable, because it’ll just happen now as it appears to be doing. So, it’s great to see such wonderful leaders in such visible positions.

Beverly Ginsburg Cooper: That’s a great note to end on.

The leadership of cancer center directors is far more diverse than ever before, and yet the quality continues. 

And I think that that is a reflection of the greatness of our country and the importance of continuing to have cancer centers that feel inclusive and welcoming to everyone, regardless of who they are and where they came from, and to help them be successful academically in their careers, in their pursuits of science, taking care of patients, serving the community.

So, we’ve come a long way, but I hope that we continue to reflect what is best in our society, which is diverse points of view, different experiences, but ensuring that we all uphold the greatest of ethics and quality standards, which I think your two preceding guests really reflect.

Paul Goldberg: Well, thank you very much for your wisdom.  And also thanks to ASCO for sponsoring this program, and thank you for tuning into The Directors.