Juicing with Gary: Episode 1 with Flatiron Health

(intro music) – [Gary] Amy Abernethy, MD, PhD, Chief Medical Officer, Chief Scientific Officer, Senior Vice President of Oncology, Flatiron Welcome to Juicing with Gary

Very excited about this morning, Amy Before we sit down and have a conversation, we're going to make a juice – [Amy] Okay – I have made a special juice for you – For me? – So I have called this one, Rising Blues

Would you like to know why? – Yes, please tell me more – Have you ever heard of a great group in the 60s called The Animals? – Oh, yeah, of course – Well, they had a great song ♪ There is a house in New Orleans ♪ ♪ They call the rising sun ♪ ♪ Mm, mm, mm, mm ♪ So I need your help to put this all together So, I'm gonna need some cutting skills You are a physician

– I'm a physician – Do you know how to use knives? – Sort of – Okay, what I'd like you to do is take these beautiful red apples and I'd like you to just cut them into quarters for me if you don't mind Now the cabbage they say, that if a male was to have one cup of cabbage a day provides 90% of the vitamin C necessary for their body And for a woman, 75%

– We always need a little bit more – Excellent, excellent, okay Turn on the juicer – Alright – Alright and take off the lid

So, let's get it in there and you can just push it right down Now look, look at this beautiful purple Oh yeah, you're getting juicy, you're getting juicy, okay – Alright, got it, okay yeah – This is gonna make a mess

Ehh, that's beautiful! Now okay, you can stop the juicer – Here we go – I'm gonna take mine and, Amy, sincerely, it's an honor to have you here And, cheers – [Amy] This'll be fun, cheers

There we go – Cheers, thanks for juicing Mmm – [Amy] The Rising Blues – Yeah, the Rising Blues, oh yeah

(drumbeat) – Well, Amy, thank you again for being here Thanks for juicing with me Now, I'm excited to learn more about you, to talk about Flatiron, to talk about cancer and oncology You're really trying to change cancer in so many ways and I'm so impressed by that But to get there, I want to go back to little Amy

How does a little girl decide that she wants to be a physician? – Well, I really thought in the beginning that I wanted to be a scientist and that became evident to me when I was a kid and I loved math and chemistry I ultimately got very interested in robotics and programming And, it turned out my chemistry teacher worked at NASA in a summer program and she invited me to come and show my stuff and see whether or not I could get into this summer program That ultimately led to a placement in the artificial intelligence lab and the responsibility for programming one of NASA's first robots – And you've been at Duke a long time

You've stayed at Duke quite a while You were a professor in the College of Medicine and then you got a PhD, I understand – I was tapped to become the Chief Resident at Duke which was usually a pretty big deal So I was very honored by this and stopped my oncology training to become Chief Resident Halfway through my Chief year, my husband got a phenomenal job offer to basically live his dream in Australia

I thought, okay, okay, now this is his chance to do his thing and so I'm gonna go ahead and leave medicine and go to Australia And, when we stepped back, what became obvious was that perhaps I could go to Australia with my husband but still have some way pursuing medicine and my training I completed my oncology training, still as an oncology fellow from Duke, but now doing the rest of my work in Australia – Phenomenal And then you come back to the States

– Yes – So, let's talk about Flatiron You've now found yourself in a senior role at Flatiron Can you tell me about the role, tell me about Flatiron? – Flatiron Health is a health technology company focused on using data and technology to accelerate cancer research and improve cancer care So, I mentioned at Flatiron, one of the things that we focus on is cleaning up the data that's in what we call unstructured documents

These are basically pdfs or digital paper So, the radiology report, the pathology report, the physician's medical case notes It's the probably the thing about Flatiron that's some of our most special secret sauce One of the interesting things that I think just basically gives a good example of how important it is to get every single data point right is whether or not a person is alive or deceased And, it turns out, that that's a really hard thing to know

We don't have a single reliable national dataset that we can rapidly pull from and use And so, we aggregate data across multiple sources Some of it we buy So, for example a grave site and obituary data Some of it we pull out of the electronic health record

And, some of it, we use that team of abstractors to pull out of places like the condolence card because the condolence card might be the best way to know that this patient has passed away And so, we pull all those kinds of data points together to now create one dataset around that variable Just that one single variable And you can imagine that, at Flatiron, we're doing that for every single variable you need for cancer research The part that I think really moves the needle most substantively is because we create these very clean datasets, we're then able to use those datasets for research and discovery

So, as a cancer patient, that leads to development of new medicines that then get back to you in the clinic – But our industry is not known for speed and you're talking warp speed This is a quantum leap for what we're used to So, what are gonna be the challenges because I don't know that the rest of us can keep up with that – Historically, it has taken somewhere between 14 and 17 years to go from a medicine that we think might work to widespread use in the population within whom it does work

That's how long it takes to develop a medicine At Flatiron, what we're seeing is we can speed up those cycles to 18 or 24 months and maybe even faster And, what we're seeing is that that's not just a notion for the future, but we're starting to see that happen today That we can speed those cycles up So, when I talk about speed, I'm talking about meaningful speed for patients

– And, Amy, I see and feel your passion, your knowledge, your experience I can understand that from a researcher's perspective and from a clinician's perspective But you've experienced it from a personal perspective Can you talk to me a little bit about your father? – Oh, my dad So, he was diagnosed in December of 2015 with a very rare metastatic cancer that had started within the bile tract

In trying to figure how to help think through his care, several pieces were important So, one is that he wanted receive this care at home Like, he didn't want to fly to Houston or New York or Raleigh, he wanted to stay in Orlando because he wanted to be a part of his community which meant that he needed to be a part of a doctoring network where the information could come to him and that was really important to him And, one of the things that I'm proud of within Flatiron is the way that we build our information networks, the way we build our software allows the best information to get to the doctor no matter what city you're in And, therefore, the patient, no matter what city you're in

So, that was kind of one thing that my dad demanded and I got to see in action The second thing was that since he had this rare cancer, every meeting that I had with a pharma client, every conference I went to I looked for the latest and greatest in cholangiocarcinoma care So I was able to look for the new drugs that were coming But the sad story, and I talked to my dad about this a lot, is that, a lot of those times, those drugs were still stuck in the lab or early phase trials and he didn't meet the requirements for those trials And so, now that we're starting to see ways that the discovery of new drugs and the figuring out of what works and what doesn't work is actually speeding up care

Although it didn't help my dad, his story helped inform how we think about how important that is He always told me, "let my story be a part of the future" And, I remember that from my time in the clinic My patients saying to me, "don't let my story end here" In our collaborative project with the FDA, what we're seeing is that, for patients with lung cancer, the majority of people are over 65 that are getting the immune checkpoint inhibitors, these new drugs that we're all talking about

Yet, almost none of those patients were included in the clinical trials Not only are we seeing that those are the patients getting the drugs, we're able to compare their survival compared to the younger patients who were treated in the clinical trials And, guess what? Age doesn't matter And, in fact, these drugs work equally well regardless of your age So that's an example of a proofpoint where, in working with the FDA, we have shown for patients sitting in front of me at clinic who's older in life, this drug is equally efficacious and is going to work equally well as a patient who's got the same biomarker as the younger crowd

And so, we're able to start using this to figure out how do we tailor care in the clinic – So this is true actionable information and we're finally making information available and actionable at the root level – At the root level The whole purpose of Flatiron is to make sure that every single cancer patient's story is a part of the future in the way that they want it to be – I'm gonna shift a little bit for a minute and I want to ask you a question

I mean, you are truly a leader in every single way I'm thinking about those people that want to aspire into leadership What advice can you give them? 'Cause you've become that leader What can you do to encourage them along? – Well so I think I have three parts to my advice The first is opportunity comes to the prepared

Be prepared and then go for it when interesting things come in front of you You don't know if you're gonna suddenly move to Australia and completely change your career over to informatics or you're gonna keep on the same path that you were on in leukemia-lymphoma You don't know what that's gonna look like, but jump for it The second is that mentoring counts Choose your mentors wisely

Have mentors that, when you come into the mentoring relationship, you understand what you're hoping to get out of that relationship, but you're also very explicit about what you're gonna give to the relationship And you treat that relationship with incredible respect and care and you show up and you're a part of that mentoring relationship Because, honestly, the mentors are gonna be who create your network and take you forward in life The last piece of advice I have for people, believe it or not, is to be a weeble You might remember that weebles wobble, but they don't fall down, right? Like, you're gonna get knocked against the head, it's not gonna be pretty, it's not gonna go the way you want, right? But, don't be afraid to just stand back up and keep on trying

Because the best way to get to the place where you want to be is to keep moving forward and not let things move you backwards – And those are three great examples The perseverance, as you said, and the weebles, you're right We all get knocked down, but how many times do we get up? We have to keep getting up and keep going for it Just like me and juicing

This is new to all of us, right? But, we're having a lot of fun doing it So, I'm going for it, right, and we're juicing – I love it – This has been a tremendous experience Thank you for spending a little time, having some fun juicing, and for helping us tell these stories

Cheers – Thank you (outro music)

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