In this episode of In the Headlines, former NCI Director Kimryn Rathmell speaks with Paul Goldberg, publisher of The Cancer Letter, and Jacquelyn Cobb, associate editor, about the HHS layoffs and their potential impact on mental health. These layoffs—and the broader uncertainty introduced by the current administration’s actions—are a form of trauma, Rathmell says.
This episode is available on Spotify and Apple Podcasts.
In Rathmell’s latest column, “Preparing to take care of each other in ways we never imagined,” she tells a deeply personal story about the loss of her father to suicide.
“It came to me as I was having conversations with people and feeling a really profound transition in the way people are talking and conveying their identity,” Rathmell says. “That really struck a chord with me. The column was written as a letter and describing an experience that really was pivotal in my life, which was when my father went through an analogous type of rapid transition in his career that culminated in him taking his own life.
Rathmell warns that, as an estimated 1,165 HHS employees face a sudden career transition, that colleagues may be in crisis.
“I know that cancer researchers and particularly people who’ve devoted their lives to cancer research really wrapped their identity into that. And so, the way in which some of this abrupt change is happening is really putting people…off their normal sources of support. And so, I wrote this because I felt like it’s something we should talk about, and we should recognize that people are having these sensations, people are experiencing this as trauma in ways that we may not appreciate.”
Other stories mentioned in this podcast include:
- On a new podcast, VCU’s Winn and City of Hope’s Carpten discuss the mission—and the future—of cancer centers
- From the chairs of ECOG-ACRIN: A perspective on indirect costs
- RFK Jr. is confirmed, NCORP stops collecting data on sexual orientation, gender. One month in: Trump’s impact on oncology
- 20 years of EGFR research: Ramalingam, Carbone, Politi, Jänne, Govindan reflect
This episode was transcribed using AI transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter podcast:
Jacquelyn Cobb (00:00): This week on The Cancer Letter Podcast…
Do you have any advice for people who are facing layoffs or advice for trainees who are dealing with this uncertainty right now?
Kimryn Rathmell (00:11): People who lose a piece of their career, it can be really, really devastating. I lost a piece of my career, even though I knew it was coming and I knew, in some version, of what format of what might come, it was actually quite hard for me as well. So, I can’t imagine if it came abruptly without any warning.
And I had the luxury of being able to say goodbye and [a] very kind transition that day. Some of these folks are receiving letters that are suggesting that it’s their performance or something that’s really incongruent with what they understand about how they had been performing their job, or what their commitment had been to the work that they are up to. That has to have an impact on how you feel about yourself, even if you knew you were completely on the right side of things.
Paul Goldberg (01:15): You are listening to The Cancer Letter Podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter.
Jacquelyn Cobb (01:30): And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research and critical conversations shaping oncology.
Paul Goldberg (01:39): So, let’s get going.
Jacquelyn Cobb (01:50): Just a heads up, this episode does contain discussions around suicide. Please be advised before listening.
Welcome to The Cancer Letter Podcast, In The Headlines. This week, we are lucky enough to be joined by former NCI Director, Dr. Kimryn Rathmell. How’s it going today?
Kimryn Rathmell (02:07): Great. Thanks. It’s good to be here.
Jacquelyn Cobb (02:09): I’ll just go through what we had in the issue last week. We had a very exciting week in terms of the podcast. We launched The Cancer Letter Podcast with the inaugural episode of the Directors series, which features two directors of cancer centers in conversation about healthcare policy.
Our first two guests were VCU’s Robert Winn, and City of Hope’s John Carpten, who talked about the importance of community outreach and health disparities research. The podcast also featured two discussants, Norman Sharpless, former director of NCI and former acting commissioner of FDA, and Beverly Ginsburg Cooper, who is the managing director for research at Huron Consulting Group.
We also had a guest editorial from the chairs of ECOG-ACRIN, Peter O’Dwyer and Mitchell Schnall, about the impact of the proposed cap on indirect costs.
We also had a roundup of all things related to oncology that happened in Washington last week, which seems like it will be an ongoing story format for us as the news outbreaks just keep coming. And that included RFK’s confirmation last week and some updates about the website purges that was our lead story two weeks ago.
And we also had a panel, a story write up about a panel of researchers who were involved in the discovery of the EGFR mutation in lung cancer where they discussed the last two decades of lung cancer research and treatment following the EGFR mutation.
Finally, we had a very powerful guest editorial by Dr. Kimryn Rathmell, who’s here. And I wanted just to put it over to you. We’d love to hear you talk a little bit about the guest ed and also the context in which you wrote it, of course.
Kimryn Rathmell (03:59): Sure. Thank you. So, first, it’s a privilege to get to write a guest editorial or a column sort of regularly, especially during this time that we’re seeing a lot of transition. I will say that from the first two columns and what I think I’ll write in the future, my plan was to write a little more about science and mentorship and the community and where we see opportunities in the future and a little less dark than the way this one went.
But it came to me as I was having conversations with people and feeling a really profound transition in the way people are talking and conveying their identity. And that really struck a chord with me. The column was written as a letter and describing an experience that really was pivotal in my life, which was when my father went through an analogous type of rapid transition in his career that culminated in him taking his own life.
This was 22 years ago. This was something that our family has had to grapple with. But to do that as a family member, but also as a physician, I’ve had some opportunity to analyze and to recognize some of that same sense of aloneness and loss of what I wrote in there: Security, safety, and identity. I think those things really kind of wrap up together.
I know that cancer researchers and particularly people who’ve devoted their lives to cancer research really wrapped their identity into that. And so, the way in which some of this abrupt change is happening is really putting people, not just pivot, but you know, off their normal sources of support.
And so, I wrote this because I felt like it’s something we should talk about, and we should recognize that people are having these sensations, people are experiencing this as trauma in ways that we may not appreciate.
I will tell you, there was another trigger that made me think to write this, which was, I just happened to go back to the Vanderbilt Department of Medicine Grand Rounds, and they always have a special speaker once a year who speaks to the humanity of medicine.
And they had a guest who was a physician in Hurricane Katrina and was there at Memorial. She’s the subject of the book “Five Days at Memorial.” And she spoke about how this event had affected her as well as colleagues and how they all experienced this very differently, and how much the—where there was sources of support—it made a difference as compared to places where there were people who might be unsure of how to offer support or unsure of how to be able to be even empathetic.
And she pointed to the fact that we need to prepare to manage the psychological stress post a disaster. Now, she was talking about hurricanes and massive events that are different than seeing some of the uncertainty around funding the layoffs and changes to how we do a lot of our work. But the end effect can be quite similar.
We’re also a group of people who like to plan. And so, I thought by suggesting that we plan and articulating a few strategic items that we can put in our pockets as we think about planning, I thought might reach people at a time when they really need it. So, that was the impetus and where it came from.
Paul Goldberg (08:20): The column really was a landmark to me, because we’ve been covering this issue as a kind of journalistic story—so many people here, so many people there. It’s kind of [like] one RIF is a tragedy, 500 is a statistic. And here it is. This is what it costs. And we haven’t done it yet, because it’s so recent, but I think we’ll be going back, probably starting this week, to cover the wreckage of this.
Kimryn Rathmell (09:04): Right. I think it’s important to realize this has been, I think, 28 days. And part of it is that we really don’t know what the future is quite going to look like.
And so, that uncertainty adds to some of the damage that people are feeling. And I think you said it exactly right. I think when we kind of put it in statistical terms or think about it in very much the abstract, then we can lose that sense of ownership or recognition that this could be us.
And in fact, it kind of is us, when a big part of our community is suddenly lost, or when we see that it’s clear that there will be things that are damaged in how we get cures for cancer into the hands of patients. And why will that happen? Because there’s not enough people to do the work suddenly, because there’s uncertainty. And so, people hold back. We can try to describe it in very specific scientific type of terms because that’s the kind of people that we are. But in fact, it’s actually quite a human relational experience that this is all happening. And so, we just have to be able to acknowledge that.
Paul Goldberg (10:32): I’m starting to wonder—just planning for the worst—what does the world look like without NCI being scientifically relevant or without cancer centers being scientifically relevant to NCI? Do you think about it? Or is it just my paranoia?
Kimryn Rathmell (10:53): Oh, I do. People know me as someone who can think through the best, medium, and worst case scenario. I’m an oncologist. We always have all of the cards on the table.
Well, we try to steer toward the best and look for the opportunities for the win-win. But we know what the worst case could be. And I think we can’t pretend that’s not a possibility. But at the same time, I really like to think that it’s not a serious possibility.
The drive for cancer research, the need of people to have more answers, more opportunities, more ways that we take care of their loved ones well, or themselves, or identify ways to prevent cancers or detect early—people really resonate with that across the board. We’ve said it so many times that this is a non-partisan issue.
There is not a partisan nature to cancer whatsoever. And so, do I think cancer research will go away? I don’t. That was not your question. Your question was, what does it mean if it’s not led by the NCI?
There are opportunities here for us to be making our ecosystem more robust, even as the NCI comes back into the strength that [it] has historically had, but partnerships with foundations that are very much a part of what we do every day, that’s super important that opportunities to partner even more effectively with with the private sector.
I think all of those things are good things, and all of those things are things that everybody wants to see. There are always opportunities to break down silos and get us into a better place.
But right now, how we’re getting from here to there and who’s funding that research and where it’s going to happen, and how do we not lose a generation of trainees and young investigators and people with great ideas—I think that’s where the real, the scary parts of this all is.
I think the most valuable things that we have at the NCI are the cancer centers, for sure. This network is unparalleled. There’s nothing like it in the world. So, I really believe that the power and what that has to offer is recognized by members of congress and will be recognized by others as well. So, that’s at core.
I think the way we fund fundamental science—we have to have fundamental science in order to have the translational, the clinical research. So, where is that going to come from? That has to come from some form of government support. So, this is where the evolution of whatever’s happening will be really, really important.
But I just want to get back to the effect on young people. I’ve had, in my weeks out, a little bit more opportunity to spend time with students. And actually, just yesterday, I had lunch with a group of MD-PhD students who are very concerned and wondering how their future looks and are there careers for physician-scientists? And will there be value in physicians having the opportunity to do research?
To me, that has not been something that’s been called into question yet. And so, I really encouraged them to keep doing their science. We cannot stop what we’re doing, in terms of making discoveries, making sure that we’re pushing that mission forward. But, there will be a breaking point where there just aren’t jobs out there, or there will be just too much uncertainty so that people choose alternative careers. That’s really going to be devastating, if that really bears out.
Paul Goldberg (15:16): I’m just wondering if there’s a way to sustain the structure of cancer centers without NCI. That was my question. Grappling with that—that’s what I’ve been losing sleep over.
Kimryn Rathmell (15:33): So, fortunately the cancer centers are connected through other groups like the AACI, the American Association of Cancer Institutes, and through a similar network of partnership that they’ve created at AACR, but that’s not quite the same as what they are as cancer centers of the National Cancer Institute with NCI designation.
So, I think that—back to telling the story—some of it is the public needs to know why a cancer center is valuable, even if they’re getting care in a local community from an oncologist who is not directly affiliated with a cancer center.
They’re still benefiting from the fact that there’s a cancer center in their state or in their region, both from the foundational discoveries that you don’t get if you don’t have the the combination of the basic scientists and the clinical researchers, but also the people who will train your next workforce, who’s going to come and take care of patients in the future.
And also the sort of deep content expertise. We need generalists and we need specialists. Cancer’s really, really complicated. We can’t all try to be generalists in this area. And so, it really takes them…
I mean, I know we’re on the same page, I know. I’m espousing the value of cancer centers, and you’re asking me “How are we going to pay for them if that’s not coming from the NCI?” or “How does that work?”
I don’t know the answer to that.
Paul Goldberg (17:17): See, I think it’s a culture. I think the cancer center is many things, but one of them is a culture, and the culture has a way of perpetuating itself. and that’s my hope is, is that structures evolve in order to move NCI along or just maintain things, kind of an exile if that’s what it takes for a while until the world comes back, that’s my probably bias.
Kimryn Rathmell (17:48): Yeah. Well, well, I, I think that the genesis of the of the cancer centers was really brilliant when it came to be, because the comprehensive nature—it includes training, it includes community outreach, engagement, and that includes looking at the communities. And that’s what people in the United States want. They want to be part of this.
And so, the cancer centers are a truly unique network of research that is a conduit to the community. And again, when I’ve talked to members of Congress, one of the things that they are always proud of is the cancer center that’s in their state, or the cancer centers that are in their state, and understand how much value there is in that.
So, I think it’s both the value that it brings, the embeddedness to which it exists in the community. I can tell you when a cancer center has had some challenges to their renewal, I got phone calls [from] people in the community, from other stakeholders, because they knew that this is something that had to be an important part of their community. So, that’s a real asset for the cancer centers as a foundation for how the NCI gets back on its feet.
Paul Goldberg (19:25): Vince DeVita used to say that every cancer center has two senators and a variable number of house members, and all of those folks are presumably using their cell phones right now to call their legislators, presumably. So, maybe you’re right, and it will all stick around.
Jacquelyn Cobb (19:50): Dr. Rathmell, do you have any advice for people who are facing layoffs or advice for trainees who are dealing with this uncertainty right now?
Kimryn Rathmell (20:01): People who lose a piece of their career, it can be really, really devastating. I lost a piece of my career, even though I knew it was coming and I knew, in some version, of what format of what might come, it was actually quite hard for me as well. So, I can’t imagine if it came abruptly without any warning.
And I had the luxury of being able to say goodbye and [a] very kind transition that day. Some of these folks are receiving letters that are suggesting that it’s their performance or something that’s really incongruent with what they understand about how they had been performing their job, or what their commitment had been to the work that they are up to. That has to have an impact on how you feel about yourself, even if you knew you were completely on the right side of things.
So, I think my message to those folks is to acknowledge how you’re feeling and to be okay to go through the range of emotions that are going to be part of it. I think there are—there’s real value in having some comradery. So, the fact that this is happening to a lot of people—to talk to others, to realize that there are a lot of people out there who support them. I mean, people who watch the news and for whom this is not personal yet, they still care and feel that this is not fair. So, I think that helps.
I think there are real resources out there. Making sure you know your resources, and there are various web links and places to go for how to navigate, just from being eligible for unemployment to how to find yourself on new job lists and how you think about whether legal action is something that you would want to be a part of.
So, I think knowing what your resources are is always important. And I just really feel for these people, and it’s hard because you see that this is not only happening at the NIH or the NCI, this is happening across lots of different areas of government, which makes it feel, I think, even a little bit more helpless because it’s not targeted. It has a little bit more of a random essence to it.
Jacquelyn Cobb (22:53): Absolutely. Well, is there anything else that you want to share with us, Dr. Rathmell, before we wrap up?
Kimryn Rathmell (22:59): Only that I did write this piece because I wanted people to know that there are people out there who have lived through this and that they care and that everyone’s life and experience is valuable. I wrote it not only for the people being laid off, but also the people who are still there, who are charged with some of the tasks of offboarding people who they didn’t have any intention to have to off board. This is real trauma for them as well.
And so, I think realizing how much people are feeling and maybe not trying to anticipate what somebody might be feeling, but just to ask, and know that this is a hard time for a lot of different people.
Jacquelyn Cobb (23:49): Well, thank you so much for joining us, Dr. Rathmell. This was really a treat, and thank you so much for promoting such an important message at such an uncertain time for everyone in our community. Thank you very much.
Kimryn Rathmell (24:02): Thank you.
Jacquelyn Cobb (24:06): Thank you for joining us on The Cancer Letter Podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com. With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate and share. Together, we’ll keep the conversation going.
Paul Goldberg (24:26): Until next time, stay informed, stay engaged, and thank you for listening.
