In the face of the unknown, two cancer center leaders discuss planning for the future, recovering from setbacks, and holding on to what they still have.
One big problem: Right now, there are more questions than answers.
“It’s hard to plan, and try to make sure that what we’re doing in the cancer research space is going to be funded,” said Ben Ho Park, director of the Vanderbilt-Ingram Cancer Center. “What programs, some of which have already been pulled, will not be pulled? Or even if they’re cut back, what is that cutback going to look like?”
Park, who is also the Benjamin F. Byrd, Jr. Chair in Oncology and professor of medicine in the Division of Hematology-Oncology at Vanderbilt University Medical Center, appeared on The Cancer Letter Podcast with Suresh S. Ramalingam, director of Winship Cancer Institute of Emory University and professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine.
Ramalingam, who is also the Roberto C. Goizueta Distinguished Chair for Cancer Research at the Emory University School of Medicine, and editor-in-chief of the journal Cancer, said that bringing in new investigators and researchers is paramount, but he worries if funding uncertainties will turn away early-career faculty members.
“We’re providing some supportive grants, pilot funds to pivot them to some new priority areas. And hopefully those efforts will bear fruit. But definitely, this has left a lot of people scrambling,” Ramalingam said. “Even if their grants have not been cut, they’re worried about whether they will be able to renew it and continue their programs. Will they be able to keep the staff in their labs employed so they can continue their research work? Have they all been topics of day-to-day conversations within the cancer center?”
Park shares Ramalingam’s concerns, not only for existing and future investigators, but also for trainees.
“The trainees, they’re not blinded to this at all,” Park said. “They’re seeing it and they’re thinking, ‘Wow, what kind of future do we have as a cancer researcher going forward?’ So, I think that there’s many downstream and domino type effects that will be felt for years to come. And we’ve seen some of it. I’ve seen attrition in some of our senior trainees who just decided this isn’t the right career path for them because it’s just too stressful.”
Park’s refrain during this time is something his father used to say: “Tough times don’t last. Tough people do.”
Park and Ramalingam appeared together on The Directors, a monthly series which focuses on the problems that keep directors of cancer centers up at night.
This episode is available exclusively on The Cancer Letter Podcast—on Spotify, Apple Podcasts, and YouTube.
“Over our professional careers, we’ve really never seen such uncertainty,” said Beverly Ginsburg Cooper, managing director for research at Huron Consulting Group and a discussant on this episode of The Directors.
“We can live with a certain level of uncertainty, but we’ve really been hit with a tsunami, and not quite sure what is ahead,” Ginsburg Cooper said.
The potential impact could be far-reaching.
“Those that are getting four- and five-percentile scores are not getting funded,” she said. “That’s devastating, both to those individuals, but also the young people who are pursuing academic careers. And some of those are starting to pull out or not enter the next class.
“The impact on the laboratories, the impact on the future generation is very real.”
While congressional support for NIH seems likely to continue, Ginsburg Cooper stressed that it’s important to be prepared (The Cancer Letter, Sept. 5, 2025).
“I am both an optimist, also determined, and part of my job is to always, as I say, plan for the gray clouds and hope that they don’t appear,” she said.
“I would say we need to stay focused, determined, flexible, and hopeful.”
Explore previous episodes of The Directors.
Some highlights:
On what has been lost
In the episode, both Park and Ramalingam offered a rare glimpse behind the curtain to reveal the measurable impact of the federal policy changes that have been enacted since January.
“All of our grants—as I think there’s no secret—that had anything to do with disparities or diversity have been removed,” Park said.
The impact of this lost funding has put strain on the cancer center.
“With that, we’ve had to actually RIF employees,” Park said. “I personally, within our cancer center, had to let go of staff. And I don’t know if anyone’s ever had that uncomfortable experience, but let me tell you, it is not fun. It is not pleasant and it’s probably the worst thing one has to do in a leadership position.”
Vanderbilt has had to conduct multiple rounds of layoffs, Park said. In the most recent round, Vanderbilt Medical Center’s strategic marketing team lost “a third of their staff in one fell swoop. And some of those people were our point persons for strategic marketing with the cancer center. So, that kind of left us also in a bind. Even though they weren’t my direct employees underneath the cancer center, it still affects us,” Park said.
Winship Cancer Institute has lost some grants in the last eight months, but “it’s been a small number,” landing in the “low single digits,” Ramalingam said. But he is still concerned about paylines and the future’s funding outlook.
“However, when we look at grants that are coming up for renewal in the next 12 to 18 months and what the impact of that with a reduced payline from what used to be ninth percentile to fourth percentile means substantial deductions in the grants that would come in as these new programs are up for renewal.”
Ramalingam is also concerned about the next-generation of researchers.
“What we’re beginning to see is people pivoting from what they have spent their careers working on and trying to find new areas to work,” Ramalingam said. “We’re providing some supportive grants, pilot funds to pivot them to some new priority areas. And hopefully, those efforts will bear fruit. But definitely, this has left a lot of people scrambling. Even if their grants have not been cut, they’re worried about will they be able to renew it and continue their programs? Will they be able to keep the staff in their labs employed so they can continue their research work? [These] have all been topics of day-to-day conversations within the cancer center.”
This funding uncertainty has forced Vanderbilt had a “cilling effect” on morale.
“We have hiring freezes for research faculty and staff right now, because we don’t know if we can commit what is really needed to sustain their careers coming in,” Park said. “And that also has a chilling effect on morale, ability or inability to grow programs. So, it isn’t, again, total doomsday, but it also isn’t just some small paper cut. It is still hurting.”
On the system under strain
This is not the first hard moment he has seen in his career, Park said.
“Ram and I think probably entered our careers around the same time. Even back in 2002, when I joined faculty at Hopkins, it was the same type of like, ‘Wow, things are getting really bad right now and the paylines are going lower and lower and lower.’ And so, I almost feel like it’s been this slow death by a thousand paper cuts, but what it is right now, it’s just like a huge slash in the wound. And it has in some ways catalyzed this.”
Still, this moment is particularly fraught for biomedical researchers, Ramalingam said.
“I would say though this time it feels different, compared to the ups and downs we’ve gone through,” Ramalingam said. “And as you said, while there is definite resilience in the system, it’s not infinite and it’s not going to last forever. I think people are looking at the events and hoping that this is something that would quickly change to a better point in the upcoming months or year or two.”
The longer the system is put under strain, the worse the impact will be, Ramalingam said.
“The longer it lasts, the effect of that turning away people who are going to come into the system, one,” Ramalingam said. “And two, even forcing some people who are at a pivotal point in their careers making decisions about, ‘Do I continue this? Do I go in a different direction?’ They may be pushed towards alternative decisions. So, those are definite risks of what we are going through.”
On hope and the next few years:
Political pressures and funding challenges notwithstanding, this moment is particularly exciting for cancer researchers.
“We are in a very exciting period. And these therapies are making patients live longer, live better,” Ramalingam said. “And in terms of the exciting research we learn about at the AACR, [and]ASCO meetings that provide a window to what’s next to come in the next few years is even more exciting.”
Ramalingam wants the community to focus on the potential scientific progress coming to oncology, and to remind the public of what federal research dollars actually do for progress against cancer.
“So, that’s the positive message that I want us to build our plans for the future on—we’re at a transformational time. And this has been made possible by investments the nation has made in the cancer programs over several decades. And this is not the time to back off.”
Park agrees.
“I would amplify that and say, this is the time to charge forward, because we have made so many discoveries in the past three decades that have allowed us to now translate those in every sense of the word into meaningful, impactful products, if you will, for our patients,” Park said.
Oncologists are “eternal optimists,” Ramalingam said.
“While the current situation is one of concern, deep concern and grave concern for all of us, the fact remains as oncologists, we are eternal optimists,” Ramalingam said. “We deal with patients who go through such difficult journeys. It’s a difficult journey but we’re inspired by them, and I feel that we will carry on forward. And I’m optimistic that not too long from now we will be discussing not the funding situation, but the exciting science that’s coming out of the cancer centers that be at Vanderbilt, Emory, or other places.”
Ramalingam’s comment reminded Park of a saying he loves to use in challenging situations:
“If you’re going to be an oncologist, we look at the glass 5% full, not 95% empty.”
Listen to the full episode on Spotify, Apple Podcasts, and YouTube.
A transcript of the podcast is available below:
Jacquelyn Cobb: Welcome back to The Directors, a special segment of The Cancer Letter Podcast. The Directors is sponsored by ASCO, the American Society of Clinical Oncology.
This time, Suresh S. Ramalingam, executive director of the Winship Cancer Institute of Emory University, and Ben Ho Park, director of the Vanderbilt-Ingram Cancer Center, talk about how their institutions are handling the uncertainty that is currently plaguing the biomedical research community.
Ramalingam is also editor-in-chief of the journal Cancer, as well as associate vice president for cancer at Woodruff Health Sciences Center, the Roberto C. Goizueta Distinguished Chair for Cancer Research, and a professor in the Department of Hematology and Medical Oncology at
Emory University School of Medicine.
Park is also the Benjamin F. Byrd, Jr. Chair in Oncology, and Professor of Medicine in the Division of Hematology-Oncology at Vanderbilt University Medical Center.
Beverly Ginsburg Cooper, managing director for research at Huron Consulting Group, appears on the podcast as a discussant.
And with that, let’s get started.
Paul Goldberg: Well, Dr. Park, Dr. Ramalingam, thank you for finding the time to join us on The Director’s podcast, where the first question is always the same, which is what’s keeping you up at night as you run your cancer centers in September 2025?
Ben Ho Park: Who you throwing that to, Paul?
Paul Goldberg: I’m throwing it to both of you, so you can flip a coin.
Ben Ho Park: I’m happy to go first, if that’s okay with you, Ram.
Suresh Ramalingam: Please.
Ben Ho Park: I think what’s keeping me and many of my colleagues up at night is the uncertainty of what’s going on at the NCI and Washington, DC, because it’s hard to plan and try to make sure that what we’re doing in the cancer research space is going to be funded and programs, some of which have already been pulled, will not be pulled. Or even if they’re cut back, what is that cut back going to look like?
And I think it’s really the uncertainty that leaves people wondering, and again, keeps me up at night. How do we plan for the future?
And I think most of us are doing some strategic thinking and planning around worst-case scenarios or mid-case scenarios, et cetera. But I think that’s occupied a great deal of my time that I would otherwise be sleeping in bed at night.
Suresh Ramalingam: Ben, I would agree with that completely. I think that’s also what I lose sleep over. I will add to that by saying the upfront funding that’s being implemented has reduced the paylines for grants substantially.
And even if we end up with a budget that provides funding at similar levels as last year, we’re still going to see substantial reduction in the paylines. Right now, for RO1s at the NCI, it’s about fourth percentile.
It’s going to make it incredibly hard for people to continue their research programs. And equally important is bringing in new investigators, new researchers, typically they would get their first grants in the first two to three years after they have been recruited.
And the startup packages go for that length of time with the expectation they’ll have independent funding at sufficient levels to sustain their labs. Now, that’s going to be a bigger challenge. And will this turn away early career faculty members from joining the faculty is another concern that I have.
Paul Goldberg: In your cancer centers, what have you lost? What’s gone?
Ben Ho Park: Yeah. All of our grants, as I think there’s no secret, that had anything to do with disparities or diversity have been removed.
And I think with that, we’ve had to actually RIF employees. I personally, within our cancer center, had to let go of staff. And I don’t know if anyone’s ever had that uncomfortable experience, but let me tell you, it is not fun. It is not pleasant and it’s probably the worst thing one has to do in a leadership position.
So, for me, that’s been a huge source of angst, because I certainly don’t want to have to do that again, but I know that that’s a possibility. So, that’s probably the biggest effect I think it has had financially.
I do think, and I share Ram’s concern about not only just existing investigators, future investigators who are junior faculty, but even on the trainees. The trainees, they’re not blinded to this at all. They’re seeing it and they’re thinking, “Wow, what kind of future do we have as a cancer researcher going forward?”
So, I think that there’s many downstream and domino-type effects that will be felt for years to come. And we’ve seen some of it.
I’ve seen attrition in some of our senior trainees who just decided this isn’t the right career path for them because it’s just too stressful.
Suresh Ramalingam: Yeah, I would say in terms of number of grants we’ve lost in the past eight months or so, there have been some.
Thankfully, it’s been a relatively small number. However, what we’re beginning to see is people pivoting from what they have spent their careers working on and trying to find new areas to work.
We’re providing some supportive grants, pilot funds to pivot them to some new priority areas. And hopefully those efforts will bear fruit. But definitely, this has left a lot of people scrambling.
Even if their grants have not been cut, they’re worried about will they be able to renew it and continue their programs? Will they be able to keep the staff in their labs employed so they can continue their research work have all been topics of day-to-day conversations within the cancer center.
Paul Goldberg: Do you have any numbers on labs lost, projects lost, money lost, people RIFed—any numbers?
Ben Ho Park: Across our medical center, I think the absolute number was in the hundreds.
In my cancer center specifically, there were probably about 10 or so. And they come in waves as we’ve constantly reanalyzed the budgets and what’s happening, and the environment, and climate around us. So, we had several different rounds or ways, if you will, of RIFs.
And we didn’t have to do it for each round, but I’ll give you an example:
On the last round, our strategic marketing folks lost a third of their staff and one fell swoop. And some of those people actually were our point persons for strategic marketing with the cancer center. So, that kind of left us also in a bind. Even though they weren’t my direct employees underneath the cancer center, it still affects us.
And I also think one of the other things, Paul, and I’m sure Ram would agree with this, the effect that this has on morale across the enterprise, clinicians, researchers, trainees, patients, staff, is really, it can’t be understated.
It is really, really hard for people to have enthusiasm and say, “I know this is an important mission, so I got to just be chipper and keep going.”
And as I said earlier, tough times don’t last. Tough people do.
But that is easier said than done.
Suresh Ramalingam: Yeah, Ben, I completely agree.
Going back to the numbers, fortunately for us, the number of grants that the cancer center itself has lost has been in the low single digits.
However, when we look at grants that are coming up for renewal in the next 12 to 18 months and what the impact of that with a reduced pay line from what used to be nine percentile to fourth percentile means substantial deductions in the grants that would come in as these new programs are up for renewal.
Paul Goldberg: Well, I love that line. It’s your dad’s line, right, Ben?
Ben Ho Park: Yeah.
Paul Goldberg: “Tough times don’t last. Tough people do.”
Ben Ho Park: Yeah, I think he actually stole that from a televangelist that he used to love watching.
Paul Goldberg: You had to ruin it.
But it brings up a really interesting question, because you have to be the toughest people in your institutions.
Are there best practices? What do you do? Do you drink a lot of coffee? What do you do?
Ben Ho Park: Coffee and beer.
Paul Goldberg: Beer. Beer is good. Vodka would be better, but you know…
Ben Ho Park: I think most of us who are cancer center directors, and I’m sure Ram shares this with me, we try to look at challenges as opportunities.
As tough as that sometimes can be, particularly right now. But as an example, I’ve been having town meetings regularly and trying to give as much information as I possibly can, because that’s a big component of it. The angst comes off oftentimes from just not knowing and not being told, “Hey, what’s going on?”
Even when we don’t know, just hearing from us as leaders of the institution to say, “We actually don’t know. Could be this, could be that.”
That goes a long way and I’ve tried to get everyone through this by saying, I’ve iterated this—and hopefully it will stick—is that, I think the way we get through this together is by trying every day each one of us to try to do one small act of kindness.
And I feel like if we could do that across this institution, across the country, we’d all probably be in a better place.
So, that’s been my shtick. The last time I had a town hall, I didn’t even do a town hall, I did a Vic Scott talent show/gong show because I really felt like we needed some morale boosting and that went really well.
So, again, I view these sometimes as opportunities that we can actually build stronger communities, get to bond and have a little fun doing it.
Suresh Ramalingam: Ben, I love your idea of do a good deed on a daily basis to help support other people.
We’ve also taken similar approaches, which is how can we best support each other as researchers, as clinicians, as educators, to make sure that we don’t lose sight of why we got into this and why we love what we do.
I would say the opportunities that are in front of us to reduce the burden of cancer are exciting. We are really at a transformational period in terms of cancer research and cancer care. The number of amazing advances that we’re seeing just year to year is incredible.
We were just at the ASCO meeting a couple of months ago and the number of practice-changing studies that were reported were phenomenal. And we’re beginning to apply these. I look at lung cancer where now if you just count the number of targeted drugs approved for lung cancer, there’s over three dozen in the United States for a variety of molecular targets.
So, I think we draw inspiration from looking at how far we’ve come. When we go to the clinics every day, we are reminded, even when we hear a lot of good news about grant funding, our patients inspire us.
And telling the stories of our patients with our researchers, sharing with them why we do this and supporting each other is really what we’ve tried to do here.
Of course, communication is key. Making sure people are aware of where are the opportunities, where are the new priorities, what do we know about potential funding pay lines on as frequent a basis as possible is also key.
Paul Goldberg: Well, Congress is not going along with this idea of cutting an age budget by 40%. Congress is not going along with the idea of forward funding. Maybe Dr. Park’s father, Dr. Park also, was right, or the televangelist that he was listening to… But how much resilience is in the system?
Ben Ho Park: Yeah. It’s a great question, Paul.
I think we’d all like to think there’s infinite resilience, but of course, that’s not realistic or even true. And everyone’s going to have their breaking point. But I still feel like there’s another old saying I’m fond of quoting. I don’t know who said it, but, “If you love what you do every day, you don’t work a day in your life.”
And that’s how I feel about my job and the kind of ability to galvanize people for a common vision and mission of good, to really try to help patients with cancer to the best of our ability, to end it, to end suffering.
And I know very few people who would think trying to cure cancer and help patients with cancer is a bad thing.
So, what you just spoke of I think says that. Congress isn’t agreeing with these huge budget cuts and they really also value what we do as a field, as an enterprise.
And I think it is something that you have to have the long vision and recognize that this is a marathon, not a sprint. And it always has been.
Ram and I think probably entered our careers around the same time. Even back in 2002 when I joined faculty at Hopkins, it was the same type of like, “Wow, things are getting really bad right now and the paylines are going lower and lower and lower.”
And so, I almost feel like it’s been this slow death by a thousand paper cuts, but what it is right now, it’s just like a huge slash in the wound. And it’s in some ways catalyzed this.
Suresh Ramalingam: Yeah, Ben, I would say though this time it feels different-
Ben Ho Park: I agree. For sure. Yeah. For sure.
Suresh Ramalingam: … compared to the ups and downs we’ve gone through. And as you said, while there is definite resilience in the system, it’s not infinite and it’s not going to last forever. I think people are looking at the events and hoping that this is something that would quickly change to a better point in the upcoming months or year or two.
The longer it lasts, the effect of that turning away people who are going to come into the system, one. And two, even forcing some people who are at a pivotal point in their careers making decisions about, “Do I continue this? Do I go in a different direction?” they may be pushed towards alternative decisions. So those are definite risks of what we are going through.
Paul Goldberg: Well, we need leadership from NCI right now. I feel it, that the uncertainty really comes from Bethesda at the moment. There’s more certainty, weirdly, from coming from Capitol Hill. Wouldn’t have thunk…
Suresh Ramalingam: I think that, Paul, my feeling is they’re doing their best. We’ve heard regular communications from Dr. Doug Lowy about how the NCI is handling the various changes in federal policies.
And they’re also rooting for all of us to, together, get through this. And when you talk to them one-on-one, it’s clear that they are under a lot of stress and they have also lost staff that used to do some of the work that is being now passed around to existing folks.
So, I have a lot of respect for what’s happening among the leaders within the NCI and the staff. And I’m hoping that as clarity comes, hopefully sooner than later, they’ll be able to guide us even more effectively.
Ben Ho Park: Yeah, I would echo what Ram said, Paul, that the NCI leadership, the current ones, are doing the best possible job they can.
And I don’t envy their task right now. But I also think getting back to what you said, it’s really at higher levels of government that hopefully can affect some bigger, more positive changes to… I’m not even sure restore is the right word, but at least get back to a point where we’re on the right trajectory of getting much needed resources to our institutions.
Paul Goldberg: Well, I certainly didn’t mean to sound negative about Doug and the job he is doing. He’s certainly doing a fantastic job.
Ben Ho Park: Yeah.
Paul Goldberg: Given the circumstances. I was more asking about how soon will there be an NCI director appointed who would be permanent, who would have the gravitas to do whatever it is… And then maybe, maybe, maybe this will be a good person.
Who knows? It could very well be.
Ben Ho Park: Yeah. I think we’re all hoping for that.
Paul Goldberg: Yeah, it would be very nice. I guess another question, and from what you’ve said though, actually going back to really almost the first questions was that you really haven’t been hit especially hard yet.
There’ve been some drops of blood, but it’s red. It’s not black, arterial stuff. Yeah, it’s a pricked finger rather than a massive bleed.
Ben Ho Park: I think that’s probably accurate. We do have other things because we are watching what’s happening very carefully and we don’t want to guess incorrectly or at least too extreme that we end up holding an empty bag in the next few months.
And so, the leadership here, we’ve made sure that the calculus is that we land hopefully somewhere in the middle. But that has meant, as an example, and I don’t know if this is true at your institution, Ram, that we have hiring freezes for research faculty and staff right now, because we don’t know if we can commit what is really needed to sustain their careers coming in.
And that also has a chilling effect on morale, ability or inability to grow programs. So it isn’t, again, total doomsday, but it also isn’t just some small paper cut. It is still hurting.
Paul Goldberg: Oh, yeah, yeah. The uncertainty must be horrific. And then your role becomes so important of being the morale-builder; right?
Suresh Ramalingam: Yeah.There are also some big outstanding items that could dramatically alter the landscape—the indirect costs conversation.
We don’t know what it’ll end up being. And that has, depending on where we land, could dramatically alter our ability to support programs and do conduct research.
The other issue, universities are also looking at is endowment taxes and how that would limit the ability of institution to support continued growth of research programs.
So, while the initial hit that we have received has definitely had an impact, what’s holding up things where they are is we’re still being funded at the current indirect rate and the decisions are still pending. So, I think that’s something I’m closely watching for to see where it ends up.
Paul Goldberg: Yeah. It could end up anywhere, right, Ben?
Ben Ho Park: Yeah.
Paul Goldberg: The indirect cost situation is so far, at least on the hill, that’s a no-go. I don’t know what that means though, right?
Ben Ho Park: I don’t think any of us do. And that again, lies the angst because of the uncertainty. And trying to plan for maybe not the worst-case scenario, but also not the best case.
Paul Goldberg: This is definitely going to have a different impact. But actually, I’ve just been thinking about this. The system that we have right now in oncology is a system that nobody would have designed prospectively.
It evolved; right?
So, the things the institutions that are now being tried and tested are not the institutions that anybody would’ve built prospectively. Cancer centers, actually, were built prospectively and designed prospectively. But the question is, what do you think the rebuild would look like after this? Because we’re not going to stop research as a country. No way.
So, is there a way to build a better system? And how do we do it in a way that helps people of your expertise, stature, leadership at the wheel?
Suresh Ramalingam: Yeah. Paul, I would say at the outset, the system we have is working well. While there are parts of it that we may feel could be improved, we have with the existing system achieved a lot as a community of researchers and clinicians.
You look at the reduction in cancer mortality in the United States in the past three decades. That’s been made possible by cancer centers, funding from the federal government. Supporting cutting-edge research and implementing that science in our communities. All of this has had a tangible impact.
So, I would say if we were to evolve, it maybe gives us an opportunity to look at parts of what we’re doing that perhaps have not worked well. And as a community, we can come together and identify those.
And maybe the reshaping of the edges will help us be more nimble as we move forward. But I don’t think a dramatic reshaping of something that’s working well would service them.
Ben Ho Park: Yeah, I would echo those sentiments with maybe some twist to that. I feel like what this current environment has taught me is that academic medical centers that live by NIH dollars will also die by NIH dollars. And by that, we’ve become addicted to it in some sense of a word. And it is the largest funding body really in the world for biomedical research.
So, I think, myself, I’m sure Ram’s doing the same thing, and many of my colleagues are all thinking about, again, new opportunities of how do we actually make a sustainable business model or plan, if you will, that doesn’t rely so heavily upon federal funding the way it traditionally has? Nobody has the right answer to that.
Everyone, of course, points to philanthropy, but I’ve also been thinking about maybe these are opportunities to partner with businesses, companies. Who knows? Maybe we could even make a competition out of it.
If you think about things like the NFL, where sports fans get behind their cities because there’s competition. Maybe we could do something creative like that as well. But I do think we have to start rethinking about not the model of how we do research like Ram said, but maybe about behind the scenes, how do we actually fund this in a way that doesn’t put us at such risk and peril that at a flip of a dime, things could go south? And I don’t think anyone wants to be in that position anymore.
So, I think most people are similar to what I’ve been thinking about is what are those other models and how could they actually work?
Paul Goldberg: Have you been thinking about community oncology and how there may be an opportunity to bring together the academic model with the community model and maybe even find a new funding stream in there somewhere?
Ben Ho Park: Yeah, I mean, I think, if you don’t mind, Ram, I’m just going to point out Sarah Cannon Research Institute is kind of that model, when you think about how they really… Many people don’t realize this, but they grew out of Vanderbilt Hematology.
Paul Goldberg: Sure.
Ben Ho Park: And started this idea of doing phase I trials in the community. And that has clearly blossomed and still creates a sustainable business plan that there are still highly academic.
In fact, one of the things I’ve been doing since becoming cancer center director is working and meeting with them regularly and trying to find ways to collaborate and have opportunities to actually be mutually beneficial.
So, I do think you’re exactly spot-on.
That is one of the areas that we’re looking into as well.
Suresh Ramalingam: Yeah. I think as we partner with community oncologists, I think some of them are already doing clinical research and engaging with cancer centers, and some of them probably not to the same extent, and there may be opportunities there.
I also want to point out that the growth of the clinical programs has been a major source by which academic institutions that use the dollars to fund research as well. And as the clinical margins change and shrink, that’s going to be another barrier for supporting research programs.
So, the community oncology groups will also have to deal with the same thing. How much can they invest in having clinical trials, clinical research infrastructure if they don’t have the margins and the clinical work that they do to be able to support these programs?
Paul Goldberg: Any other opportunities that you see? Any other thoughts? Or actually maybe we should even look at what the process could be for a discussion of what the rebuild looks like. I’m just trying to get some traction going on that idea.
Ben Ho Park: I also think if one really ponders about ways to make money, because that’s what we’re all talking about, coming up with the business plan of even selling products or selling services is, I think, the way that we need to be thinking about cancer in the future.
And making sure that people know, “Hey, you want to go to Emory because of X, Y and Z. Vanderbilt has a B and C, and that’s what we are best known for. And so, people should come here.”
And then, as I was getting back to before, we could have even local pride in competition. I don’t know if there’d be a Super Bowl of cancer centers, but I think you get what I mean. And I think that those are the areas where traditionally academics have never really done well in. That we’re not really good at selling ourselves and saying, “Hey, we need to do this because we have a great product. We want you to consume it. We want to actually profit from it, but not profit in the way that we’re going to get rich off it. That’s our future researchers. That’s our future cures for cancer.”
Suresh Ramalingam: Yeah, I agree. I think at our center, we’re looking at how do we expand our philanthropic base, which everyone I’m sure is doing the same thing, reach out to foundations that may have an interest in this area and also businesses, corporate entities.
Those are things that we need to start thinking about. Are there things that we do that may be of mutual interest to them in the realm of cancer screening, early detection, cancer prevention? Those may be areas where corporate entities may have interest for their employees.
Or are there things that we can do together to foster research and have clinical programs that are focused on early detection?
I think some of the ideas Ben threw out makes a lot of sense. How do we collaborate with each other as a community to identify those sort of opportunities?
Paul Goldberg: Well, you both have institutions located in red states. And what’s your sense of support you have from your congressional delegations?
Ben Ho Park: I think personally, Paul, as I said this earlier, one of the things that is in my mind never really been bipartisan or has been bipartisan I should say, is the fact that cancer is an important problem that cuts across everyone and everywhere, the human race, everything. So, I have not felt unsupported.
I feel that there are clearly things that I wish Tennessee as a state would do better, but I don’t think it necessarily is a red state thing, because one of the things I was trying to get some traction on is to replicate what the state of Texas has done with CPRIT.
I think that’s a phenomenal example of how the citizens of the state of Texas have voted and decided they want to really invest in cancer, cancer research, cancer care. And that’s what I think a lot of states can do.
So, I was going to steal their acronym, call it CPRITN for Tennessee instead of Texas. I haven’t gotten much traction on that yet, because there are some hiccups along the way. But I would really love to get an audience with our governor, our state and local representatives because I think, again, trying to make it into a competition, like I said earlier, would be really, I think a lot of fun, but also would galvanize a lot of folks here.
We could be the Tennessee Titans of cancer and say, “Look, we’re going to be better than the state of Texas.” And the CPRITN will be CPRIT and raise all this funding and get really amazing results out of it. That will be the end game.
Paul Goldberg: That’s a genius idea. State bond issue.
Suresh Ramalingam: Yeah.
Paul Goldberg: Yeah. Have you thought of something like that, Suresh?
Suresh Ramalingam: As Ben said, we’ve also felt that support for cancer researcher is bipartisan. Whenever we’ve had a chance to engage with our state delegations, they have always expressed their support for cancer.
They’re always open to hearing about patient experiences, how research is impacting patients in their respective districts. Winship at Emory does not have any formal state funding for the cancer center, like some other states provide. And we’ve also had some conversations about having a statewide funding mechanism like CPRIT.
Georgia used to have a program about 15-odd years ago, which allowed… And when I came to Georgia, that was because of funding mechanism that was supported by the state that paid for recruitment and funded research dollars for people to be recruited from out of the state.
And not just Winship, but the entire state of Georgia with institutions including Morehouse, Medical College of Georgia, which is Augusta University now, University of Georgia, all benefited because there are a lot of researchers that came here to work thanks to that support.
It would be great if our state would revive that sort of a mechanism so we can support existing researchers. Doesn’t necessarily have to be restricted to researchers that you’re recruiting. At least to support existing research programs, high priority areas.
We know what are the critical needs of the patients in our state from a cancer standpoint. Where are the greatest opportunities? We have the knowledge to inform that sort of a decision-making process.
Paul Goldberg: Yeah. That was tobacco money. That was tobacco settlement money that was used to recruit my friends to Georgia.
Ben Ho Park: When I was at Hopkins, they had a similar thing. And I think it’s still there.
Paul Goldberg: It’s still there.
Ben Ho Park: The recruitment fund. Yeah.
Paul Goldberg: You know what we haven’t heard from was we haven’t heard from patients yet. And we’ve heard from congressional delegations, I think pretty clearly that the consensus on cancer research is still there very much on Capitol Hill, but the patients haven’t spoken yet. How do we get patients heard? What can we do?
Ben Ho Park: I actually think a lot of patients through various organizations have been speaking out.
Paul Goldberg: Good.
Ben Ho Park: And holding multiple Hill Days, both locally and federally. Our American Cancer Society folks here did something like this locally. And so, I do think that voices are being heard, that people are speaking up.
And again, I think this cuts across everywhere because it really resonates. You put someone, a young woman, for example, with kids in stage 4 metastatic breast cancer. And how does anyone not think that we need to do more work to cure that patient someday?
Those are the things that I think we all agree upon.
And so, it’s just a matter of being, I think, persistent and sending a unified message.
I was on a Hill Day myself and Ram was there too, and it actually was revealing to me. We met a lot of the congressional aides, and they didn’t know about what we do or how we do it and the importance of funding.
So, public education goes a long way and it’s still something I think we are not as good as we should be. The responsibility really, I think does lie upon academic medical centers to showcase all the good that we’ve done, but we’re not very good at it, I think because we’re very busy.
And also, I think in some ways we’ve been trained not to be too boastful and making sure that we’re not sending messages of false hope is what I was once told. At the end of the day though, I think that it isn’t false hope, at least not anymore. It is real. And we have plenty of examples that speak to that.
Suresh Ramalingam: Yeah. Paul, my experience has been patients are listening, they’re paying attention to what’s happening. When I see patients in the clinic, the topic comes up with many patients about clinical trials, what will happen to cancer research, what will happen to their ability to continue to receive the treatments they are on.
I’ve had a patient ask me, “Hey, I’m on a clinical trial. Will my ability to continue on the trial be affected if the funding cuts come true?”
So, they are paying attention. They are willing to make phone calls to their congressmen and senators if needed. And I think the Hill Day and other events have definitely been a tool by which they have been able to communicate in addition to our ability to communicate with our legislative leaders. I think the way forward for us would be to make sure that we tell, as Ben said, the key accomplishments that have happened because of the funding, and make sure that the appreciation is conveyed to our legislators along with concerns that our patients are happy to join in whatever call to action that we come up with to help with the situation.
Paul Goldberg: Well, at The Cancer Letter, we should continue to profile patients and do this at least once a month, maybe once a week even, ideally. What is the most hopeful thing you can say right now? What would be the most encouraging message that we could end on?
Ben Ho Park: You want to go first, Ram?
Suresh Ramalingam: Yeah. I just look at how exciting it is to be practicing oncology, taking care of patients today.
I mean, I was seeing patients this morning in my clinic. And a young woman who was hospitalized with severe symptoms just about six weeks ago is now symptom-free because of presence of targetable mutation and starting targeted therapy. And she’s now back to work.
So, we are in a very exciting period. And these therapies are making patients live longer, live better. And in terms of the exciting research we learn about at the AACR, ASCO meetings that provide a window to what’s next to come in the next few years is even more exciting.
So, that’s the positive message that I want us to build our plans for the future on is we’re a transformational time. And this has been made possible by investments the nation has made in the cancer programs over several decades.
And this is not the time to back off.
Ben Ho Park: Yeah, I would amplify that and say, this is the time to charge forward because we have made so many discoveries in the past three decades that have allowed us to now translate those in every sense of the word into meaningful, impactful products, if you will, for our patients.
One of the things that my own lab has worked on for 15, 16 years is these liquid biopsies for circulating tumor DNA in breast cancer.
And we just presented this at ASCO, and again, AACR meetings and things like that that Ram was talking about that allows us to disseminate that knowledge. But equally important, I think this is really going to allow us to figure out, okay, is this patient cured or not cured?
That’s something that haunts patients with early stage disease because they’re living, walking on eggshells all the time. Not everyone, but many people. And so for me, that was kind of what I saw as a huge unmet need and many of my colleagues across the nation and the world. We’re now at a point where we’re almost there.
And that’s going to be game changing in how we think about cancer, how we treat cancer, how we even do clinical trials.
We don’t have to enroll every single patient knowing that in breast cancer, 60 to 7% of them are already cured, statistically speaking. So, we get to do much more focused, smaller, efficient, cheaper trials that will only translate into faster drug approvals and get even more patients cured. This is, as Ram said, hugely exciting time. And it is something where right now I think we need to push on full steam ahead.
Paul Goldberg: Well, let’s hope that happens. I think maybe your dad was right.
Ben Ho Park: Tough times don’t last. Tough people do.
Paul Goldberg: Ram, any thoughts?
Suresh Ramalingam: I completely agree with Ben. I think while the current situation is one of concern, deep concern and grave concern for all of us, the fact remains as oncologists, we are eternal optimists. We deal with patients who go through such difficult journey.
It’s a difficult journey but we’re inspired by them, and I feel that we will carry on forward. And I’m optimistic that not too long from now we will be discussing not the funding situation, but the exciting science that’s coming out of the cancer centers that be at Vanderbilt, Emory, or other places.
Ben Ho Park: Ram, you reminded me of my own saying, not my father’s. I love to tell people this. “If you’re going to be an oncologist, we look at the glass 5% full, not 95% empty.”
Paul Goldberg: Well, thank you very much.
Ben Ho Park: Thank you so much.
Suresh Ramalingam: Thank you, Paul. It’s my pleasure.
Paul Goldberg: Well, our discussant today is Bev Ginsburg, who knows everything. Bev, what are some of your thoughts upon hearing this conversation?
Beverly Ginsburg Cooper: I thought the center directors who you interviewed really did a magnificent job, Paul, of characterizing the current environment and what we’re seeing in terms truly of best practice among our center directors.
This is unprecedented time. I don’t think either one of us will confess to how many decades we’ve been doing this, but over our professional careers we’ve really never seen such uncertainty. And we can live with a certain level of uncertainty, but we’ve really been hit with a tsunami and not quite sure what is ahead.
I think also they were exceptional at talking about the importance of leaders today, both bringing their exceptional talents from the academic environment and combining it with smart business principles. You know, we live in the academic world.
Nonprofit environments are very different than the for-profit, which I was in before getting into healthcare and then ultimately in cancer centers. But I’ve also always applied principles where they’re synergistic and I think that that’s the way in which we’re going to be able to best navigate both the uncertainty, try to build confident and stable leadership at the helm of each of the centers and stay united together.
Paul Goldberg: I was kind of pressing them on this, and how much of an actual harm have they sustained? There’s a lot of uncertainty. Uncertainty is a harm.
Beverly Ginsburg Cooper: Yeah.
Paul Goldberg: But what about just actual, financial, quantifiable harm? And you have to be also careful—I’m sorry to be asking such a long question—but you have to be sort of careful to not say, “Oh, well, it’s just DEI, you know, just a little flesh wound.”
Beverly Ginsburg Cooper: That’s exactly right, Paul. It may be that their individual centers are not feeling the pinch, but, you know, I work around the country with large and small centers, and so, the impact is quite different, depending on who you speak to.
There are those names in the newspaper and they’ve been hit very hard. There are others that are very concerned that if they poke their heads up a little bit, they will be on the fire lines. But let me give you some examples. First and foremost, to hear, as I did throughout this week, as I was at a center, those that are getting four and five percentile scores are not getting funded.
That’s devastating, both to those individuals, but also the young people who are pursuing academic careers. And some of those are starting to pull out or not enter the next class. So, we’re going to find a lot of problems in postdocs, which are the brain power and leg power of our labs. So, we may have a hiatus, and that could be 5, 10, 20 years of the next generation.
A couple of weeks ago, I was at a dinner we do for external advisory boards, and I was privileged to be with some of the very preeminent investigators who have had consistent three, four grants for many years and have contributed significantly to changing the course of cancer treatment. And they weren’t sure about the future of their centers, their laboratories.
The impact on the laboratories, the impact on the future generation is very real.
The actual grants, you’ve gotta put in so many more to get one, they’re not seeing the decline yet, but we’re starting to see, as we look year over year, the 10, 15% decline. And that’s just the beginning, because we’ve got a tail for those grants that it continued, right, that are in year 2, 3, 4.
Publications in the next three, four years will start to decline. So, I think this is the, in some ways, the calm before the storm in terms of the research publications, which are the evidence that new discoveries have unfolded and their new treatments.
We’re also seeing a divide between the haves and the have nots. Those that have very deep war chests of endowment, philanthropy, state funding, they can continue to thrive for a while on those funds. The lower resource centers, the underresourced states, you’re going to start seeing a greater impact there than ever before.
We’re also not yet seeing the impact on Medicaid and other things that are more in the clinical realm, but our health system solvency—their ability to generate clinical revenue that can support clinical trials, you know, those trials that we keep open because maybe somebody will come through the door and they need a clinical trial, rather than big trials where you can easily accrue.
Those are going to start falling off, and that’s going to hurt our ability to continue to make great strides.
So that’s where I’ll add to the conversation, but change it slightly from what I heard from the two centers. But that is what I’m seeing around the country, and I do believe that it’s going to get more serious as we go another 6, 12, 18 months.
Paul Goldberg: There’s a rumor that people who got their CSGs approved in the most recent cycle haven’t been paid yet. Is that true? Have you heard that?
Beverly Ginsburg Cooper: Well, they wouldn’t get paid because you’ve got the review, then it’s gotta go to the NCI parent group, which makes the funding decisions. So, that’s not atypical. But those that I’ve worked with that submitted and just went through their reviews, I haven’t heard anything unusual. And I have one or two administrators who would reach out to me immediately.
So, I don’t know that there’s any problem. And it’s just right now customary
Paul Goldberg: So, we’re still okay. Well, also Congress has been pretty great in terms of helping out with this. The 40% cut probably is not going to take place—likely, almost certainly. So, maybe, this will pass. Maybe this will be okay.
Beverly Ginsburg Cooper: Well, I’m going to stay with your optimism, Paul.
Paul Goldberg: You share it?
Beverly Ginsburg Cooper: Partially. I am both an optimist, also determined, and part of my job is to always, as I say, “Plan for the gray clouds and hope that they don’t appear.”
So, I think as a community, and I want to also applaud the work that The Cancer Letter has done. You’ve been really strong advocates. But as we band together and work with our Congress leaders as well as our state, I think people are understanding that we are all here just to take care of patients.
This was not revenue generation by any means. Research loses money, and we were all focused, I think, very much on the right things, which is how to prevent cancer, how to control it once it arises, and how to give everybody the very best chance for cure. We need to continue to convey those messages in a way that each audience, each stakeholder, understands.
That may be, as you always advocate for, the patient message. But we also… I work with basic science centers and we are working on their communications on how basic science provides the technologies and the platforms that affect change across the country and across the globe.
Others that are more pop-sci-focused may have a different message.
So, we have to do a better job than just assuming, and working with each of our congressional leaders as well as state leaders on “why cancer.”
It saves lives, it provides economic returns.
When you look at the economic analysis that we’ve done around the country, cancer centers bring in $10, 15 billion a year in economic return. They help businesses grow and thrive. They get people back to work faster. They give people who are in the middle or early stages of their professional careers the ability to get back to work and continue to be contributors.
So, cancer impacts all of us. We just need to make sure that we are providing succinct messages that resonate and are very respectful of those that question us, because they don’t always understand what the added value of research is.
Paul Goldberg: I guess the role of the director has changed. I’m seeing it from having done this, The Directors, since the start of the year now. It’s kind of a psychiatrist-in-chief without a license, among other things.
What are you seeing?
Beverly Ginsburg Cooper: Their role is certainly to help their members, their trainees, keep the faith, stay focused on why we are all doing this, which is to find a better cure and give hope to the next patient.
Paul Goldberg: I just love that line, “Tough times don’t last. Tough people do.” That was kind of apparently pilfered from a televangelist.
Beverly Ginsburg Cooper: Well, that was pretty funny. I would say we need to stay focused, determined, flexible, and hopeful.
Paul Goldberg: Well, thank you. This is the most perfect closing remarks I’ve ever heard.
Beverly Ginsburg Cooper: Well, as always, it’s great fun talking to you. Thank you for all that you’re doing for us and giving a great voice to the leaders and to all of those in every cancer center that are getting up every single day and helping to create hope for the next patient who they see.
