In last week’s issue of The Cancer Letter, the cover story featured something special: The first de novo book published by The Cancer History Project. The book, “Backwater to Blockbuster: St. Jude Children’s Research Hospital,” co-written by Charles J. Sherr and William E. Evans, chronicles the previously untold story of St. Jude Children’s Research Hospital and its rise to becoming a global leader in pediatric cancer research.
This episode is available on Spotify, Apple Podcasts, and Youtube.
In this week’s episode of The Cancer Letter Podcast, Paul Goldberg, editor and publisher of The Cancer Letter, talked about serving as an editor for the book.
“I said, ‘Well, if you want, the Cancer History Project, which publishes books, could make this our first de novo book project,’” Paul said that he told Sherr and Evans at the time. “‘And if you want to work with an editor, I have one for you: Me.”’
“And so, in my spare time, I became an editor for this book.”
The book is available at no charge on the Cancer History Project website.
“And it’s fun because it’s kind of a story about the time the Giants walked the earth—giants like Chuck and Bill—by the way. And the cool thing is that there’s only one way that the Cancer History Project can publish a book, which is to make it free,” Paul said.
In other news, FDA has authorized fruit-flavored vaping products while easing enforcement against illicit products awaiting premarket review, a move critics argue opens the door for major tobacco companies to expand into the flavored vape market.
This authorization was the final straw for former FDA Commissioner Marty Makary, who resigned as a result.
In this week’s episode, Jacquelyn Cobb, associate editor of The Cancer Letter, and Sara Willa Ernst, reporter, join Paul to talk more about these stories.
“It was definitely something new, but it wasn’t causing too much alarm among the cancer researchers that I was talking to,” Sara said. “But then a few days later, what we thought was a story turned out to be a different story—which, this is our life in the news and working in journalism. But FDA essentially said, ‘Hey, we’re taking a different approach when it comes to enforcement. So, we will be cracking down pretty much on the black market, but one subsection of the black market and not another subject section of the black market.’ Particularly, they will no longer be prioritizing enforcement for black market products that have a pending pre-market application. And so, the experts that we talked to, whether that was a legal expert or other kinds of cancer researchers, they were saying that the way that it might shake out is that the major tobacco companies such as JUUL, that pretty much aren’t on the market right now, they kind of have a pathway to be able to put their own products on the shelf without FDA giving them a hassle.”
Stories mentioned in this podcast include:
This episode was transcribed using 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: This week on The Cancer Letter Podcast…
Paul Goldberg: It’s the first ever history of St. Jude that’s book-length. I thought it was fascinating, because of the voices of the people who tell it. Bill was a CEO for many years and Chuck is of course one of the premier scientists who made the place what it became, which is one of the real scientific blockbusters, but it’s also financially quite an amazing operation. Why? You’d spend a lot of time, you might get some money, but that’s not their goal here at all. Their goal is to tell the story and to make it as available as possible, as widely as possible. So, I did get them a conversation with an agent.
Jacquelyn Cobb: I didn’t know that.
Paul Goldberg: An agent my agent was somewhat my agent. And my agent was very excited about it because he thought he could sell that book.
Jacquelyn Cobb: Oh, really? Wow.
Paul Goldberg: Yeah, yeah, yeah, yeah.
Jacquelyn Cobb: I’m getting so much new information, I didn’t know about this.
Paul Goldberg: He said he could do it. He could play. He could do it. He was excited about it actually because St. Jude is such an enormous part of American culture.
You’re 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: 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: So, let’s get going.
Jacquelyn Cobb: Hi guys. How are you?
Sara Willa Ernst: Good.
Jacquelyn Cobb: Yes, big giggly, giggly intro today. Paul made a joke right as we counted down the cut. What is that called? Is there anybody here in media enough to know when the director’s little… Do you know what I’m talking about?
Paul Goldberg: Give him a jag.
Jacquelyn Cobb: No, you don’t know what it’s called? A bunch of journalists, we don’t know what happens on Broadway or in Hollywood.
Paul Goldberg: In Hollywood.
Sara Willa Ernst: On Broadway.
Paul Goldberg: On Broadway as well.
Sara Willa Ernst: Truly have no idea.
Paul Goldberg: So, much we don’t know.
Jacquelyn Cobb: Clearly. So, hi guys. Thank you for joining me. I have both Paul and Sara on the podcast today because they will talk about their stories from last week. Well, actually technically the story Paul is going to be talking about Claire was a big part of writing, but he is going to talk about the whole process of the story, which is a little bit of a teaser, but we will dive in. So, our cover story was a story about a book that the Cancer History Project has published. It’s called Backwater to Blockbuster. And I’m not going to say too much more about it because really that’s the convo I’m going to have with Paul.
I’m really excited about it, but it’s the first de novo boo that the Cancer History Project and sort of the cancer letter franchise, I guess, has published. Not the first book we’ve published, but the first de novo. And Paul will get into the details, but it’s really exciting for us. So, really excited to kind of just gush about the process and what that was like. Then we had a story, Sarah’s story, which is what she’s going to talk about a little bit more about FDA clearing fruit flavored vapes and relaxing the enforcement on black market products with pending pre-market applications.
I kind of just read the headline off of that one because it’s a pretty wonky, complicated story, which is part of why we would like to chat about it in more detail. And then our last story was Claire wrote about Marty Makary leaving FDA kind of interlocked with Sarah’s story, story too, about fruit flavored e-cigarettes or vapes because those two things kind of happened in lockstep a little bit. It seems that the fruit flavored e-cigarettes, these sort of things that are happening at FDA that Sara’s going to talk about were sort of the final straw a little bit for Makary.
So, they’re kind of related, but Claire did a really lovely job diving into sort of what he was like as a commissioner, what his sort of role was at FDA and what he did while there. So, very rigorous story as well. And then we have some cancer policies, but I’m not going to get into too many details because I think we have a lot to talk about today. So, Paul, if you want to start about Backwater to Blockbuster, do you want to give just the elevator pitch for what the book actually is? I guess this is a very leading question.
Paul Goldberg: It’s the first ever history of St. Jude that’s booking. I thought it was fascinating because of the voices of the people who tell it. Bill was a CEO for many years and Chuck is of course one of the premier scientists who made the place what it became, which is one of the real scientific blockbusters, but it’s also financially quite an amazing operation. So, just sort of genius really. So, he tells the entire story from, they tell rather the entire story. And it was interesting how the book came about. I was talking with Chuck, which I often do about, I don’t know what, or he just called me and I call him just to call him sometimes because it’s fun to talk to him.
And he mentioned that he and Bill are working on books and different books and they were trying to put them all together and he showed me a manuscript and I told him, “Well, you could do this and this and this.” And what’s interesting with a book like this, which has, there’s tremendous interest in it and yeah, to tell the story the way they could tell the story, which is like from the inside, the inside of the inside, you kind of had to get into kind of the definitions of what makes a standard book For a trade book, I don’t know what it would take to make it a trade book. I think a lot of people would probably buy it, but I said, “Why bother with that?” And they also said, “Why bother with that?” Because why?
You’d spend a lot of time, you might get some money, but that’s not their goal here at all. Their goal is to tell the story and to make it as available as possible, as widely as possible. So, I did get them a conversation with an agent.
Jacquelyn Cobb: I didn’t know that.
Paul Goldberg: An agent was somewhat my agent. And my agent was very excited about it because he thought he could sell that book.
Jacquelyn Cobb: Oh, really? Wow.
Paul Goldberg: Yeah, yeah, yeah, yeah.
Jacquelyn Cobb: I’m getting so much new information. I didn’t know about this.
Paul Goldberg: Yeah, yeah, yeah, yeah. He said he could do it. He could play. He could do it. He was excited about it actually because St. Jude is such an enormous part of American culture.
Jacquelyn Cobb: Mm-hmm. Yeah, it is.
Paul Goldberg: But I think we would be talking about a somewhat different book than the one that they really both Bill and Chuck had. And then getting into academic process, that also is a whole different kind of set of limitations. And I said, “Well, if you want the Cancer History Project, which publishes books, could make this our first de novo book project. And if you want to work with an editor, I have one for you, me.” And so, in my spare time, I became an editor for this book, but I’ve written a number of books and I’ve been edited. I’ve never edited a book, but I’ve certainly been edited.
Jacquelyn Cobb: So, this is the first one? This is the first book?
Paul Goldberg: I’ve never edited the book. No, there’s no reason to. I’ve written books.
Jacquelyn Cobb: Yeah, I’ve edited your own…
Sara Willa Ernst: I did your own work.
Paul Goldberg: Yeah, I’ve edited my own work. I’ve worked with editors. I mean, I’m writing my fourth novel and I’ve written three nonfiction books. So, I mean, I know what to do.
Jacquelyn Cobb: You have it. Yeah.
Paul Goldberg: So, I know kind of what to do and what I looked at was my first thought about this book was, “Hey, you’re going to have a much better time if you just go to first person singular, split the thing up and just go from chapter to chapter.” And they did. And really just the book clicked because voice is one of the most important things in the book in any book.
Jacquelyn Cobb: In any book. I knew that was coming. I knew it.
Paul Goldberg: Yeah. So, the result was this really fun story of which I knew chunks of it by the way. There’s like one particular moment that I thought was really fun. In Chuck’s story, he is trying to recruit Tom Curran to come to St. Jude to be head of the Department of Developmental Neurobiology. And Tom’s a really fun character, fun guy, friend of mine. And he said, “Yeah, yeah, yeah, yeah, I’ll do it except there’s something you got to do for me, Chuck. Stop smoking.”
Jacquelyn Cobb: Wow.
Paul Goldberg: And that was his condition of employment. So, he made Chuck stop smoking. That’ll do it. It wasn’t originally in the book and that was kind of like my stuff. And then there was also a bunch of apocryphal stories or maybe they just didn’t really spread around. Who knows? And I checked them out and neither Bill nor Chuck knew them, which means they’re not in there, but I love the apocryphal story. But in this case, it was really fun to get the current story. Oh, and when it was all over, he actually made a little certificate for Chuck that he has successfully stopped smoking, which is great because That’s friendship.
Jacquelyn Cobb: That’s really lovely.
Paul Goldberg: Yeah, that kind of stuff needed to be in there. And then when you start thinking about the characters who are in there, Danny Thomas, the story of how his vision and why and how and then of course characters like Joe Simone, right?
Jacquelyn Cobb: Mm-hmm. Yeah.
Paul Goldberg: There’s a lot and a lot and it’s fun, because it’s kind of a story about the time the Giants walk the earth and giants like Chuck and Bill, by the way. And the cool thing is that there’s only one way that Cancer History Project can publish a book, which is make it free.
Jacquelyn Cobb: Yes. I was just about to go there. Ah, read my mind.
Paul Goldberg: Yeah, which is fun because just download it and there you have it. We have published books before. It’s just that they were republications of books that are very important in oncology, like Simone’s Maxims, for example-
Jacquelyn Cobb: Exactly.
Paul Goldberg: … and certainly the history of the National Cancer Act, which I think is one of the best books on the subject I’ve ever read. So, it’s a lot. Yeah. But this was the first one where we said, “Oh heck, let’s do it.” And we probably, I mean, it took a while because there was this election that we had and one of the consequences of the election was that we were all chasing our tails pretty hard so that what little slack we had in this organization was gone. So, it took a while, but it was so worth it.
Jacquelyn Cobb: Yeah, it was so worth it. And it also, I feel like there were iterations. It also needed time. Book publication was not a short process in any way and we’re not a book publisher. We also have a journalism to do and package also.
Paul Goldberg: We, nobody told me. I was crazy enough to think that we could easily do it. We did it, we did it well, but it wasn’t an easily done process.
Jacquelyn Cobb: No, it definitely took a lot of effort. I mean, I think like I said, I feel like any book publication is going to be incredibly challenging logistically and just like a huge chunk of text like that needs a lot of time to just make sure it’s like correct and good and all the things.
Paul Goldberg: And Chuck and Bill were just so fun to work with because they’re both just great storytellers.
Jacquelyn Cobb: Yeah.
Paul Goldberg: Yeah. Different backgrounds completely and just coming out one’s from Tennessee, the others from the Bronx lived kind of catty corner from the polo ground stadium. It’s like stories, stories, stories. And then the NCI story Chuck tells is incredible. What is the NCA story? Well, just his stint at NCI and how not harmonious, how far from harmonious horror stories. Yeah. But they’re in there and they both wanted to tell the horror stories too.
Jacquelyn Cobb: Well, that’s what I was going to say is that what I really liked about the story in the cancer letter that we wrote about the book was, and you kind of alluded to this, Paul, but the idea that they had both independently started writing histories of St. Jude, clearly there’s so much to say and I feel like if they’re both writing histories, of course that means that there are a lot of stories.
Paul Goldberg: And we kind of skimmed the cream of both of these memoirs, stuck them into one.
Jacquelyn Cobb: Oh my gosh.
Paul Goldberg: Yeah. And I’m kind of a voice junkie, so I was really getting them to go and get voicey.
Jacquelyn Cobb: Oh, yeah. Love it. Love it. Just to say it properly, this book is available for no charge. You can download it as an ebook and a PDF from the Cancer History Project. We will put that link in the description.
Paul Goldberg: Yeah. Actually, there’s also a possibility of getting it in a little bit in a few weeks, we will add the capability of the print version, but the print version is going to be print on demand.
Jacquelyn Cobb: Yeah, print on demand. It’ll have a tiny charge just to literally cover the printing, but it’s like $2 something. Don’t quote me on that.
Paul Goldberg: No, I think it’s more, but whatever, but it’s not a whole lot.
Jacquelyn Cobb: Oh, not a whole lot.
Paul Goldberg: And who cares? I mean, it’s not… Yeah, it’s just… Yeah.
Jacquelyn Cobb: Yes, yes, absolutely.
Paul Goldberg: But it’s available on either PDF or on your reader.
Jacquelyn Cobb: Ebook. Exactly. Wonderful. Well, thank you, Paul. I feel like we could really talk about this for hours, so I’m going to have to sadly… Well, not sadly. I’m excited to talk to Sarah about her stuff too. So, from one good thing to another, do you want to give us your sort of elevator pitch, Sarah, for the story so that we can have somewhere to start from?
Sara Willa Ernst: Yeah. So, the first half of last week’s issue was St. Jude, but the second half was FDA, FDA, FDA, FDA. I mean, to steal a word from Paul has been a snafu at FDA lately and there’s been a lot of changes in leadership, and it’s kind of centered around one of many parts around this regulatory news around flavored vapes. So, we thought the news was one particular thing, which is that the first fruit flavored vapes have been authorized by FDA. So, this is the company glass and they have two flavors. They have mango and blueberry. I think they’re called gold or sapphire to catch you off guard a little bit. But no, basically mango and blueberry.
And yeah, I mean, we thought the story was a bunch of advocacy groups coming out saying, “Hey, we oppose this.” Whether that was the American Lung Association, whether it was the campaign for tobacco-free kids. And we spoke to a couple of cancer researchers or people that are working on tobacco cessation and they were telling me that they thought it kind of was a good idea, the authorization because this particular authorization had certain age gating, age verification technology, which we don’t know at the moment truly whether it’s going to block kids from being able to access it.
But there’s some interesting ideas being thrown around, particularly that you need to have a Bluetooth connection to a phone and you’ve already gone on that phone, you’ve already given your government issued idea and verified your age. And once you’re outside of that particular proximity of your phone, the e-cigarette locks. It’s an interesting idea. Will it work? Will it not work? And the FDA has certain provisions or contingencies or expectations to follow up, collect data and see whether or not the marketing of this product is actually reaching children.
Well, it was definitely something new, but it wasn’t causing too much alarm among the cancer researchers that I was talking to. But then a few days later, what we thought was a story turned out to be a different story, which this is our life in the news and working in journalism. But FDA essentially said, “Hey, we’re taking a different approach when it comes to enforcement.” So, we will be cracking down pretty much on the black market, but one subsection of the black market and not another subject section of the black market, particularly they will no longer be prioritizing enforcement for black market products that have a pending pre-market application.
And so, the experts that we talked to, whether that was a legal expert or other kinds of cancer researchers, they were saying that the way that it might shake out is that the major tobacco companies such as JUUL, that pretty much aren’t on the market right now, they kind of have a pathway to be able to put their own products on the shelf without FDA giving them a hassle. And so, there’s a lot of concern around the black market because with the authorization, maybe it has some age gating technology, maybe there’s some obstacles for kids to not be able to access it, but we’re talking about, given the current circumstances, a whole out of control black market that really isn’t being taken as seriously as it should by FDA and that is causing a lot of alarms.
Jacquelyn Cobb: Yeah, yeah. I think you said this, but what stuck out to me, just if I frame it how I was thinking about it was the first half of the week, what you were telling me, and so I was just kind of like being an editor, staying up to date on what you were reporting and you were telling me like, yeah, it’s sort of this weird kind of story where obviously our instinct, especially as oncology reporters is like, “This is bad.” You don’t want more stuff on the. But like you said, people were talking about using it to help current smokers stop using cigarettes. So, that’s the one, and that I feel like makes a lot of sense. There’s a lot of research in that. That’s a world and another thing.
Paul Goldberg: Yeah, but hold on, but there’s also a very living, very live controversy over this.
Jacquelyn Cobb: Yeah, that’s what I was going to say. The other side is that the concern specifically with fruit flavored vapes is that they are marketed or they are appealing to children. And so, there was a quote or maybe you wrote it, I’m not sure, in your story that was just so powerful about never-smokers being exposed when they’re really vulnerable. It’s like, “Oh, mangoes, it tastes good.” And I think we had a conversation last week about just what it was like on campus, like on a college campus when jewels came around.
Sara Willa Ernst: Yes. Oh my God.
Jacquelyn Cobb: Yeah. Paul…
Paul Goldberg: I have no idea.
Jacquelyn Cobb: Yeah.
Sara Willa Ernst: I was in college in 2019, which was the absolute peak. Oh wait, no, I graduated 2018. I’m lying.
Jacquelyn Cobb: Well, you were for a couple of…
Paul Goldberg: You stuck around.
Sara Willa Ernst: But it was building up. It was building up in popularity at the time. I was telling Jacquelyn that I had studied abroad and had been exposed to a lot of cigarette smoke in Europe. And then I came back thinking, “Wow, I’m going to have some fresh air in my lungs.” And then everybody and their mom has a jewel on campus and it just happened very, very quickly and then it pretty much peaked around 2019.
Jacquelyn Cobb: Yeah. And just like the haze of very different smoke, it feels different. I mean, I’m sure I actually have…
Sara Willa Ernst: Sounds good.
Jacquelyn Cobb: So, like cotton candy, right? Yeah.
Sara Willa Ernst: Yeah, cotton candy smoke.
Jacquelyn Cobb: Yes, yes. And that’s the thing, Paul, there’s this whole culture that’s already existing. And I think anyway, the whole point of what I was saying was that when you were reporting on this part of the story, that first section, it was like, this is not great. We don’t love this, but really the issue is the black market. You know what I mean? The issue is that kids have access already. And with this really intense Bluetooth thing, whether or not it actually works, but it’s like there are several pretty annoying barriers to get through to be able to smoke this one that’s been approved that your mom bought or something, whereas the black market where kids themselves can just walk in and get things.
Paul Goldberg: To a gas station.
Jacquelyn Cobb: Yeah, gas stations, smoke shops, like very low and related to the second piece of news that came later in the week, they don’t say necessarily that it’s legal, they’re not changing their regulatory stance on fruit flavored vapes being accessible on the black market. They still have it as bad, whatever their sort of phrasing is, but they just said that they’re not prioritizing anymore the enforcement of this.
So, that was a very weird, I don’t know, just like reporting on the story and I think I’m just kind of speaking almost from an emotional reader perspective where it just feels like not so great I think to be like there’s all of these things coming together that are just concerning about children getting access to these fruit flavor vapes. And again, specifically thinking about Sarah, you and I understanding what that looks like. It’s on the ground a little bit.
Paul Goldberg: Well, I don’t think they’re assigning top priority to situations where-
Jacquelyn Cobb: Mm-hmm. Yeah, true.
Paul Goldberg: … vape is on the market, but there is an application pending.
Jacquelyn Cobb: Yeah. So, that’s what they’re not prioritizing anymore if I’m correct, Sarah. I would ask her to ask you to check or confirm, but it’s that there is this huge black market, right? Is that where they suggested that they were kind of redirecting their efforts? Because to me, it read just the limited bandwidth type situation that they’re not really going to be focusing on that and sort of prioritizing other things.
Sara Willa Ernst: Well, my understanding is that FDA is trying to prioritize more of the illicit Chinese disposable vapes that are these like crazy candy flavors and have sometimes cartoons on them and they might pop up and FDA might try to yank them off the market and they might show back up with different packaging. That seems like that will, based off of the language and the guidance, it seems like that’s going to be more of the focus, but while they’re not really paying attention to those with pre-market applications, it’s kind of opening the door for these large tobacco companies to bring their own products to market.
Jacquelyn Cobb: Yeah. Yeah. Gotcha. Well, that was a really good summation. Thank you. Oh, sorry, Paul. Did I interrupt a joke? That’s terrible.
Paul Goldberg: Sorry, you did. Domestic producers.
Jacquelyn Cobb: Mm-hmm, there you go. The domestic producers will…
Paul Goldberg: National interests.
Jacquelyn Cobb: Are we going to guess that we’re going to get some cartoons on the domestic produced e-cigarettes, should we?
Sara Willa Ernst: Well, that’s also another point. Specifically in the guidance, they said we’re going to deprioritize enforcement unless a domestic producer puts a cartoon character on the packaging or markets it in a way that’s obviously trying to appeal to kids. So, that is a caveat in there too.
Jacquelyn Cobb: I mean, that’s great. I’m glad to hear that for what it’s worth, not that my… I know FDA is waiting to hear my opinion, but that’s great to hear.
Paul Goldberg: Joe Camel.
Jacquelyn Cobb: What about Joe Camel? The cigarette?
Paul Goldberg: Well, no, Joe Camel was the cool character who was used to plug camel. So, that’s the cartoon situation.
Sara Willa Ernst: And this is good that Jacquelyn doesn’t know this, that she wasn’t victim to the marketing and people of our generation, that went over our heads. That’s good. That’s a good sign.
Jacquelyn Cobb: This was wonderful. Is there anything else that I missed before we sign off?
Paul Goldberg: I have nothing.
Sara Willa Ernst: I think that’s it.
Paul Goldberg: You walked us through this masterfully.
Jacquelyn Cobb: Thank you. Thank you. That is my job. That’s what I train for every weekend on podcast tuning.
Paul Goldberg: Yes. You bet.
Jacquelyn Cobb: Yes. Awesome.
Sara Willa Ernst: I thought you were just passed out on your couch trying to recover.
Jacquelyn Cobb: That’s awesome, Paul
Sara Willa Ernst: That is the training.
Jacquelyn Cobb: That is the training. There you go. Exactly. I’m watching TV. It’s social. There you go.
Paul Goldberg: You’re watching TV. Yeah.
Jacquelyn Cobb: Well, thank you guys. I will talk to listeners next week and I’ll see whichever of you is on next week as well. Thank you.
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: Until next time, stay informed, stay engaged, and thank you for listening.
