The science of cancer and care

Dr. Brandon Blue is an oncologist and physician-scientist at Moffitt Cancer Center. As a medical doctor he spends his time treating blood cancers, so this is an apt episode for Blood Cancer Awareness Month.
As a researcher though he's trying to understand more about disparities in diagnosis and treatment of such cancers so that all patients receive better care.

Brandon is also a big proponent of outreach, wanting to give back to his family, friends, neighbors and other community members. Whether we're talking about holding Facebook live sessions on COVID-19 or coaching his kids' baseball team – Brandon is a firm believer in stepping up to the plate.

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Find out more about Brandon’s work and research interests on his webpage, or keep up with him on Twitter.

Thank you to Tampa band Black Valley Moon for allowing us permission to use their very Tampa-themed track “Gaspar’s Revenge”. Check out all their work on their bandcamp page.

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If you want to enjoy the snaps of the beers and glorious outdoor space at New World Brewery, you can also consume this episode on YouTube. Subscribe now for all future recordings.

Episode transcript

[Background intro music playing is a track called "Gaspar’s Revenge" by Black Valley Moon]
Parmvir: All right. Howdy friends thank you for tuning into another 2scientists episode where inspiring scientists share their work with you, wherever you'd like to listen. Um, I'm your host Parmvir and today is a weird one for us as it's the first time since February, 2020, we are recording in person, but since we're outdoors spaced out and the three of us, including our guest are all vaxxed, we feel pretty good about being here, back at our spiritual home of the New World Brewery. Speaking of our guest today, we have the pleasure of chatting with Dr. Brandon Blue an Assistant Professor of Oncology at Moffitt Cancer Center.

How are you doing Brandon?

Brandon: So far, I'm happy to be here. Things are good and life is good. So ready for a wonderful interview. This is gonna be great.

Parmvir: Glad to hear it. I love the enthusiasm right at the beginning.

Brandon: Let's keep it going.

Parmvir: Yeah, for sure. So before he met up with us today, Brandon sent a little blurb describing himself as a kid from St. Pete, those of you who don't know where St. Pete is it's not in Russia. It is another city in the Tampa Bay area in Florida.

And he grew up to be a doctor and came back to his community to cure cancer for his hometown. So there are a lot of gaps in that description [Brandon laughs].

Can you tell us what you've been doing since leaving St. Pete and coming back to Moffitt?

Brandon: Yeah. You know that is a good summary because everything does come full circle, you know, but fortunately, I did have some cool stops along the way.

So you know, I left St. Pete I got excellent training at Florida State. And had some excellent undergraduate years. I don't remember them too much because I was in the library most of the time, but it all paid off. Right. When I was at Florida State, we were the number one party school in the country.

[Parmvir laughs]

So it was difficult because like I could like hear screams of people, like having an excellent time, but I would have like a test the next day.

But fortunately I made some good decisions at a very young age. That landed me up in medical school, which I was in Nashville, Tennessee at Meharry Medical College. And also had a wonderful time there. That's where I met my wife. Who's also a doctor. And so you know, she was also a study partner for me and she's a lot smarter than I am. [Parmvir laughs]

And so no seriously, and so I made it through medical school really by her teaching me some study tricks and some things that I didn't know along the way. And and then we both left there and went to St. Louis, Missouri. I was at a Washington University, one of the top you know, kind of medical institutions in the country.

And we stayed in St. Louis, oh man, maybe close to seven years. And then we got a chance to come back to Tampa Bay in 2018. And I've been here ever since. So it does come full circle.

Parmvir: Not that this interview is about your wife, but what does she specialize in?

Brandon: She's a neonatologist. So she takes care of premature babies.

So, you know, I always tell people, you know, the bun likes to cook in the oven, but sometimes it comes out a little bit before it's due and whenever they come out a little early, she's the doctor who takes care of them when that happens.

Parmvir: That's an adorable analogy.

Brandon: Yeah. Well, you know, it's tough because the unfortunately the patients that she has are like the size of your hand, you know what I mean?

And they're, and they're very small and then says she does some very cool things with kids that are very small. And so you know, technically they should still be in the womb and now they're out to the world. And so that does create some problems.

Parmvir: I'm sure. But obviously we're here to talk about you today. And so what I wanted to ask about is your specific field of interest is in blood related cancers. So can you tell us what happens in these conditions? What goes wrong and how common are they?

Brandon: Yeah, so this is unfortunately the, what we call the backstage of cancer. So out in front stage are the breast cancers, everyone's heard about lung cancer, prostate cancer, even colon cancer, you know, those kind of have the you know, the, the opening act and the closing act.

But really the behind the stage workers, the things that nobody really sees are the cancers such as lymphoma, leukemia, and what we call multiple myeloma. All right. And these are what we call blood-related malignancies, or we call them hematologic malignancies in the medical field. And so these unfortunately are not common at all, but they are very important. Unfortunately, because they're not as common they're not known about. And so if they're not known about, then people don't know to get checked for them. And so if you don't get checked for them, unfortunately we see them as very advanced diseases and advanced states. And unfortunately, sometimes that leads to not the best outcomes.

So, it is a very critical disease and something that is out there. But unfortunately it's just not enough notoriety out there. So I appreciate podcasts like this. I can kind of spread the word a little bit, just so people can hear about it. It might be the first time they've ever heard of multiple myeloma or lymphoma or leukemia.

And if they don't know about it, you know, hopefully they can kind of start Googling. This is kind of starts that hamster wheel turning.

Parmvir: Yeah. I guess the association with leukemia is usually with kids, right? So people might have heard about it in children.

Brandon: Yeah. Yeah. But unfortunately, it is what we call a bi-modal disease.

Meaning that like there's two peaks, you know, there's a peak early in life and that's typically one that people kind of know more about because it happens in children, but unfortunately that wave goes down, but it also comes back up later in life. And you know, just like I said, everything's full circle, you know our wearing diaper sometimes happens in early age, in an elderly, you know, us being dependent on others happens at early age, also in the elderly. So unfortunately this is one of those diseases that kind of, unfortunately it does a very similar thing. And so it's kind of a very commonality issue.

Parmvir: Yeah.

David: A question for you though is, are they really the same disease? You talk about two different peaks. Are they the same kind of cancer or very different?

Brandon: You mean as far as the

David: I mean young versus old.

Brandon: So it's a little bit different, right? So as far as the actual diseases themselves, like what the cells look like, they're very similar. Okay. But unfortunately how we treat someone who's 65, maybe different when we treat someone who's six. Right? So sometimes the treatment is really what's different even though sometimes the actual like on a molecular level or on a cellular level, maybe the same cells that may be going wrong, but unfortunately you've had 65 years to develop issues. And so the treatment can't be the same sometimes.

Parmvir: So let's backtrack a little bit and go into what it is that causes these diseases. So what, what goes wrong in our bodies for these blood cancers to arise?

Brandon: Yeah.

So that's a great question. So, you know as people know that the cells in our bodies divide and grow, we make new ones and the ones that we have don't last as long.

So new ones need to be made. Unfortunately, there is a problem sometimes in what we call the maturation process. So meaning that like this would be a good analogy. So, you know, if you think about a baby, you know, it kind of hangs out in the womb for nine months, then it comes out into the world. Typically, unless my wife has to save 'em, but, but, but typically nine months into the womb. But how it starts at month one, it's much different than what it looks like at month nine. And so there's a maturation process that needs to happen. That's normal part of life. And that same things happen with our cells. And sometimes the cells get stuck in that month, one or early stage disease, but they continue to grow.

So imagine a baby looking like what a month, one month baby looks like, but just getting bigger. We know that that's a problem, right? Yeah. And so unfortunately when that happens, that happens typically inside of our bone marrow. Cause our bone marrow is typically the spot where we make these new cells. And then it really creates a lot of problems.

So that's, that's typically where most of the problems happen is that as the cells are dividing, unfortunately they decided to go left when they should've went right. And that just happens a lot of times as we age, because if you think about it, you've had the most chances for something to go wrong, right? Like if you're only driving your car once a year, your chance to get into a car accident are super low, but now you drive, you know, an hour or two every day, the chances just go up.

And so as we age, the same thing happens.

Parmvir: Yeah. That makes a lot of sense. So how do these things manifest themselves in the body? So when a person gets sick, you're saying that, you know, you want people to be able to understand, to look for what might be going wrong. What happens to a patient when they develop these kinds of cancers?

Brandon: So, you know the brain has a funny way of normalizing things. So for example, in lymphoma, we get these lumps and bumps in what we call lymph nodes. All right. Lymph nodes are typically in your neck, underneath your chin also as well as under your armpit and in your groin, very common places. Okay. You might say, oh, this bump here is nothing.

Or, and then, you know, you start to normalize it because your brain thinks, of course I don't have cancer. There's nothing wrong with me. And you really don't notice it until, like, for example, you see family for Thanksgiving. Well, we used to see family for Thanksgiving, but you know, but typically the holidays is really a big time for us because, you know, we say, grandma, why is your neck so big? Or, you know, what's happening there. And you look completely different than what I would expect. You need to go get that checked, you know, so, so a lot of times it's very subtle things that typically don't happen in other cancers.

So as I mentioned, those front stage cancers, breast cancer, lung cancer, for example, is very intuitive to your brain to say, hey, there's a lump in my breast. That should not be there. Let me go get that checked or, Hey, unfortunately, I'm having blood in my stools. This shouldn't happen. Let me go get that checked. But when you tell someone, Hey, I'm having fatigue and I'm tired. Like they ask their other friends who are like in their sixties or seventies and say, hey, are you tired?

They say, yes, of course. What do you mean? [Parmvir laughs] You know unfortunately one of the conditions called multiple myeloma likes to attack the spine. So then that causes back pain. But then you asked your other friends who were like, hey, buddy, are you having back pain? They say Sure. What do you mean? You know, and so, and so unfortunately, a lot of the incidents that we see are like incidental, you know, or when like, again, like I said, the disease is at a very late stage where it's caused like, a spinal fracture or something where it's, you know, very dramatic.

And so I do appreciate sometimes we do see people early when we can follow them throughout the course of the disease and really start treatment at an early stage to have the better outcome, you know, kind of at the end of the day.

Parmvir: Yeah, so what are the treatments for these kinds of diseases?

Brandon: Yeah, unfortunately a lot of times it's very intensive chemotherapy.

Okay. But the great news about time is that things change. And so what we had available in, you know, 2011 is different than what we're doing in 2021. So one of the newest and latest and greatest things that's really affecting these blood cancers is what we call immunotherapy, basically using our own immune system to, instead of fighting off some bacteria or virus or fungus that we have to make sure it attacks actually cancer cells.

And so that's one of the like latest and greatest and kind of, exciting things, you know, like I'm always getting like, you know, sweating now thinking about it because it's just so exciting. And you're really offering like really state of the art therapy and a treatment for people who really may not have had some options.

And so it's a game changer.

Parmvir: Yeah, so explain how these things work. I mean, these days I feel like given pandemic and so on, most people are a bit more familiar with immune responses than they ever were. Can you explain to us how those, those technologies work?

Brandon: Yeah. So really if you think about.

And I'll try to keep it simple. But really the main fighters that we have in our body are what we call T-cells and B cells. Okay. And so these T-cells are really like the infantry in the military. Their job is to really kind of kill things right there on the ground and really get rid of things almost like hand-to-hand kind of combat.

Okay. Yeah. And so they're very efficient at doing that because that's the job that they've been doing your whole life. But typically what happens is that, you know, you get you know, the flu or the cold, or God forbid COVID or some issue, and these T-cells really help your body get rid of them. That's why you might tell somebody say, oh you got a cold, you'll get better in a couple of days because really that's how long the war the war is. And the battle is that the body takes to get rid of that. Well, so we thought say, well, let's use the same killing mechanisms. What we do is we take out someone's T-cells or these fighters, and we kind of train them to fight a new enemy. And so there's a process that takes to do that. Typically we have to kind of identify a target.

You can say, Hey, instead of looking for that COVID or looking for that bacteria, this is gonna be your new enemy, right. This is going to be your new target and the T-cells say, okay, they just like killing things. And so unfortunately it happens that a lot of people have a lot of cancer around. And so if we tell them that's the target and it gets rid of it.

Parmvir: It's, so is there the possibility with these things that they start killing too many of the things? Cause obviously you've, you've got healthy cells as well.

Brandon: Yeah. So that's where picking the target is super important. Right. So for example one of the mechanisms that we use for these T-cells is There's certain markers where I tell people certain hats that the cells wear, you know, and so, you know, we tell them, say, Hey, if it's a green hat, you know, leave it alone, don't touch it.

If you see a red one, get rid of it, you know? And so that's where picking the target gets tricky and complicated because you want to make sure that there's enough of those red hats on the cancer cells and almost none or zero of those red hats on normal cells. And so that's why The field is expanding and we're still learning, right.

Because we know more now than we did a year or two ago about our own normal cells. So that kind of helps educate us on really how to make sure we kind of can kill the cancer cells.

Parmvir: Yeah. So we're talking a lot about the kind of physician side of your work, but you also do research. Can you tell us about the kind of work that you do?

Brandon: Yeah. So Unfortunately, there are a group of people that really don't respond equitably to treatment. All right. Whether that be an access to treatment or even from the actual outcomes, getting the same treatment. They either sometimes even present at a later stage or they're just groups of people who unfortunately just don't get the same results.

And I didn't think that was fair, you know? And so my job as a researcher in that department is to really try and figure out why these disparities in these certain populations exist and what can we do about it and how can we make, kind of even the playing field a little bit to kind of make sure that if we have some latest and greatest technology that is reaching the people with the greatest need.

Parmvir: So describe how that looks in terms of like real world works that you do. How, how do you set up experiments and trials?

Brandon: So you know, I like to say that, you know, with really any new innovation, there comes a new opportunity for disparity. And so what that means is, is that we have some new, let's use these carT-cells for example, this new great groundbreaking exciting, new treatment that we know works. Okay. And then we say, all right, well if the people who unfortunately die from this disease, don't get this. Problem, then that means the gap will only get bigger. Right. Because that means that the people who are already doing well, when we give them the treatment, they will do that much better.

Yeah. And so what we try to figure out is, is first of all, education, right? Yeah. Like, is that the problem? Right? Like if we educate people enough about, Hey, we put something on a billboard or we give you a brochure, like this is a cool thing. You should do it. Is that enough? We don't know. So we have to research that.

Or is it actually the doctors? So I fortunately work at Moffitt Cancer Center which is a great academic institution that does a lot of groundbreaking research, but that's not really where most people get their cancer care. Most people get it at the doctor that's five minutes across the street from their house. And so what we need to do is educate the doctors, right?

We have some kind of new groundbreaking thing that can kind of really help patients. The doctors don't know about it. They don't know the complexities of it. So it's our job to kind of do that. And so we have to research, how do we do that effectively? Another thing. Now, if the doctors know about it and the patients know about it, how do they get to Tampa?

You know as you know, Florida is more than Tampa and Disneyworld and Miami, you know, there's a lot of like what we call rural parts of Florida that unfortunately make up the majority of the state. And so access to the care also is a problem. So, so it's really multifaceted of really trying to make sure that even if people who come from, you know The middle of nowhere, Florida, that we make sure that they still get access to this care.

So it's, it's, it's kind of multi-pronged approach. And so there's no one way to really kind of shorten that disparity or that gap. And so we, we do kind of multi-phase approach when we do our research projects.

Parmvir: Yeah.

So do you find that there are particular groups of people who are, you know, they're bigger sufferers from these disparities?

Brandon: Yeah. So typically right now from the research, what we know is that typically African-Americans and people of African descent have really had kind of a wide disparity. Unfortunately it's not even unique for these types of cancers that I treat these blood cancers. It's the same thing for breast cancer.

Unfortunately, black women unfortunately have the worst outcomes. If you look at lung cancer, black men have some of the worst outcomes. If you look at colon cancer, we not only get it at an earlier age. So for the most part of America, we say, Hey, you should actually get screened at 50 years old. That's kind of your 50 year old over the hill present. Unfortunately, in an African-American male 40 is really the recommendation in some, in some groups. And so because if you wait till 50, now we already have an advanced disease. And so and so this is something that is spread out really among multiple different cancer types. So we do know race is a big factor, but again, like I mentioned location to the latest and greatest care, or even doctors also creates a barrier.

There's a small town in Florida where my family grew up and it's in Madison, Florida. It's, it's really kind of up near the panhandle about an hour away from Tallahassee and really, you know, kind of access to high quality specialists and, you know, they just don't have that there.

And so if you tell someone, Hey, you need to see an oncologist. For me, sure. I'll go right down the road within five, 10 minutes. There's an oncologist on every block. But if you say, well, you got to take an hour and a half to get there, then it's a whole story, right. Cause that's an hour and a half there, hour and a half back. That's three hours out of your day. So then you say, all right, well, when am I going to get a day off from work? And then, you know, and it just becomes a whole other, kind of issue that really isn't as easy as people think sometimes.

Parmvir: Yeah. And I think, I mean, if nothing else COVID has certainly done an incredible job of highlighting kind of health disparities for people, not just nationwide, but worldwide, because similarly in the UK, the people who've suffered, the worst effects have been from black and brown communities and it's you know, it's a matter of how do we address those within the medical community as a whole, not just for a particular disease or.

Brandon: You know, I think a big problem too, at COVID exposed how kind of polar things are in America, unfortunately. So I'll give you an example. I don't think people knew that there are kids who don't have access to wifi. So they, so the solution was, oh, just have everybody do it from the internet. There are kids that I know personally who had to go to an McDonald's parking lot and get McDonald's wifi in order to use to go to school. This is their school - in a McDonald's parking lot. And that's, and that's not in like, you know, some third world, or this is literally, you know, here in Florida, you know?

And so, and so I think that. There's just a lot of things that just weren't known to a very marginalized group. Right. And so, you know, we talk about healthcare, but you know, it's financial care. It's what we call the social determinants of health, you know? So that's education, that's health, there's transportation.

You know, the list kind of goes on that where you have some marginalized group of people who unfortunately have these worse outcomes, but it's not just in one sphere. It's unfortunately, because they all blend, right? Like, you know, I always tell people that, you know, healthcare is not very black and white, right.

Because you're a person, right? Not only are you you know, a set of organs and heart beating and function, you also have like a life. You have a family member, you have, you know, some kind of social interactions with people. You have a job or not have a job, you know? So it gets very complicated, especially, you know, in a country where a lot of your insurance is tied to your employment, you know?

And so that just creates a whole nother issue. You know, happens all the time that I see.

Parmvir: Yeah. And I think when we're talking about racial groups, one of the other things that people are now starting to realize is that race is not necessarily determining, determining the likelihood that you're going to get particular disease.

And even for me as a biomedical scientist, I think it's probably only been in the last like five years or so. It's occurred. It's, it's not because Indians have a particular set of genes that they're more likely to suffer from diabetes. It's more likely to be either lack of education. So I know my family is in the UK and both my parents were born in India.

And there you have language barriers and other issues, like, as you said, who gets educated about these things, right? I'm sure that you've, you've experienced the same things here. Have you had to kind of have this conversation with people? It's not just because they're black or brown people. It's not their genes that are dictating this.

Brandon: Yeah. You know, honestly that's the age old question, right? Is it nature versus nurture, right? Honestly for a lot of times we don't know, unfortunately there's not enough work in this type of field for us to really answer that question effectively. So a lot of times we assume certain things and we say, well it's because you know, this person's uninsured or this person has a fifth grade education or this you know, we, you know, but sometimes actually the smarter, we get an our detection of like, for example, the human genome, and actually look at some differences. There are certain things that we're able to kind of detect that maybe a group of people may have a propensity for a certain mutation or allelic change or something that can really kind of predispose them to having unfortunately, a worse outcome at an earlier age. So we're still learning about that. And so there's always going to be a balance. It's never going to be all nurture all nature, you know, but, but I think, you know, we're learning how to identify people and kind of really kind of put them in what we call an at-risk group at an earlier age. And hopefully that leads to a better outcome.

Parmvir: Yeah. So kind of related to this, I, I know that you've spoken on the subject of kind of social justice within medicine. So this is obviously a much broader point of view, not just related to a specific disease. Can you tell us more about that?

Brandon: You know, it's everything's intertwined, right?

And so just because someone is a doctor doesn't mean that they don't watch and see what happens to, you know, unarmed Black men in America. Right. You know, just because someone is in health care doesn't mean they don't see certain injustices, for example. I don't know if you saw that Serena Williams, you know, one of the world's greatest tennis players, you know, she almost died during childbirth, right.

African-American women, unfortunately, even can't have babies at the same rate as other folks. And so it just a lot of times it becomes frustrating, you know, that it doesn't really necessarily matter the stature. Right. And so a lot of times people like to you know, kind of hinge upon the past and say, Hey, these things are things that happened a long time ago and you know, I'm not my father, but you know, I mean, this happened to Serena like two years ago.

Right. I mean, there's things that happen, almost daily that I see that really kind of spark a big question of really what's happening in healthcare for certain groups of people. You know, they, they created what they call a vital sign. So a vital sign is something that a nurse or someone in the healthcare profession has to assess because it's a vital part of their function.

They assessed that pain was one of those vital signs to say, Hey, I need to know how this person's pain is doing. Unfortunately, there's a perception out there and there's research to support that people believe that because of the color of your skin, your level of pain is different. There's this there's data on that.

And so imagine if you have some kind of chronic pain conditions, such as things like sickle cell, which unfortunately affect people of color. Yeah. Right. So now sickle cell presents, as you asked about how things present, it, doesn't present as, you know, a lump in your breast or something else. It presents as pain.

And this is your one, one way your body is telling you, because the way we were made the body typically gives us signs that something's off. Right. And so it's up to us to listen to those signs and say, all right, let me get it checked out. So if your body is saying, Hey, there's pain go, go seek help. And then you go to the emergency room, like, Hey, my body's saying, Hey, this is really a painful thing for me.

And someone's like, nah go home. Take some Tylenol. You'll be okay. Or, you know, you're writhing in pain and they unfortunately take the person ahead of you who really doesn't have as an acute of an issue, you know? And so there's a lot of these kind of subtle things that are happening in medicine that I really hope we can turn around and so that's why, you know, that's part of my job is to really kind of make sure that you know, I can kind of be an example and kind of make sure, at least at Moffitt that we do a great job of being mindful about some of these what we call implicit biases that people have.

Parmvir: Yeah. So are there kind of standards for these things within medicine or,

Brandon: Well, they're hard to measure, right.

And unfortunately, just being completely honest. They've been in the underbelly of medicine since the beginning. Right. So it's hard to kind of measure something that has always been there. Right. And they're very subjective things. And unfortunately, even like mask wearing, right? Like you see, we do something different in Florida than what they do in New York.

Right? Like, so even something very simple, it gets very difficult to: number one enforce to like police, to tell people, to get people to believe in. This is the honest to God truth. I have patients right now who told me that they thought that the Coronavirus was a political scare and they didn't believe in it.

And so when you see things like that, and you hear things like that, you know, it's hard to kind of flip the coin and kind of tell people, say, Hey, there's people who are hurting out there and we really need to have kind of a, a mindful ear and really kind of have our heart and eyes open. It's, it's, it's unfortunate.

Parmvir: Yes. I know one of the things that we were told about you, this sounds really terrible. Like people talking about you behind your back. But all good things, all good things is how much it matters to you that your local community get good information. Yeah. So how is it that you contact and serve your community?

Brandon: So this is where I'm from. These are my people, the people who I treat with cancer are people I went to class with people. I grew up with in elementary school. These are their parents. These are my actual family members. Right. And so this is important to me. And so I think that at the very least, what I can do is say, Hey, what I know, you guys need to know.

This is something that even as simple as someone getting a second opinion in certain communities, a second opinion is looked at as, duh, like why wouldn't I get a second opinion? And like, this is important and my life is important my health is important. Like it's kind of intuitive, but there's some people who look at it as what they call disloyal.

Right. They say, oh, I love my doctor. There's no reason I would cheat on him or, or her, you know? And they believe it. So there's a, there's a cultural stigma sometimes even with something as simple as getting a second opinion, which from someone who sees a lot of second opinions, I change a lot of therapies because I'm like, Hey,I think, you know, there's new data that shows, you know, drug A plus drug B is better than drug A alone. Does that make sense? So I don't think that doctors are intentionally, sometimes trying to do things, but, you know, as we know, it's like what we call drinking through a fire hydrant. There's a lot of data out there. The internet gives you so much different things. You got to have a way to filter it. And so having a second opinion as a way to have a second eye and somebody to look at it. And so what I do is I try to educate people to make sure. They know as much as I do, whether that's going out into the community to do things such as, so local kind of churches or community events. We have at Moffitt where they call the ask the expert. And so what we did with ask the expert is I was, I guess the expert, I don't know why they call me that, but really I got to go back to St. Pete and really give some great talks to people who had some of these kind of rare cancers, these blood cancers, and because sometimes, of course this was before COVID, but people just needed to kind of like make sure that they were okay. They had never heard of these cancers before. And so people didn't know there was a little uneasiness or unsteadiness there. And so asking the expert really anything that they want it to I think really gave people a big deal of relief and, and help, so I would imagine we will continue to keep doing those.

Parmvir: That's so interesting. Like the idea of loyalty to your doctor never even occurred to me. So I think it just goes to show, and this is something we talk about in science communication is knowing your audience, like the way you best serve them is to understand what their needs are and what their kind of like cultural behaviors are and how best you can approach them.

Brandon: Yeah.

I mean, I think the problem also is that, you know, the amount of, of African-American men who are physicians hasn't changed in 50 years. Right.

Parmvir: Oh, wow, really?

Brandon: So, you know, there's been a big push to, you know, get women, right. So now if you look at most medical schools across the country, they're really almost half and half, which is remarkable.

And, we've made great strides in really providing a lot of female physicians. But unfortunately, if you look at those same medical schools from, you know, 2005 and 1965, you know, they really look almost the same.

Parmvir: That's wild!

Brandon: It is wild. And so it's hard if you have a workforce of people who don't understand the culture, they, and again, I don't think it's intuitive or intentional. I just think that they're just unaware. And so, and so you have a patient who might be from an outside community who might come in and have more reservations. So then you say, all right, there's some new treatment. As I mentioned, this car T is the latest and greatest groundbreaking changing lives. And now you have somebody who you don't really connect with telling you, Hey, there's this new thing. We want you to be the one to get it.

They're not going to, what, what do you mean? I'm not a Guinea pig, right? Yeah. We hear that all the time. Right? Look at the differences in COVID vaccine utilization among races. It is remarkable. And so this is not something unique to oncology. This is not something unique to even healthcare, right.

This is really a social and racial issue that that we need to kind of improve. And, and that's why I'm here.

Parmvir: Yeah.

For most things, you, you feel like, you know, there's got to be some incremental change within kind of demographics doing certain areas of work. And I, I didn't realize that it's so bad that it hasn't changed in 10 years.

Yeah, that's awful.

Brandon: Yeah. 50 years.

Parmvir: Oh yeah. I was going to launch into expletives there. Well we'll resist that.

Brandon: Yeah, it's unfortunate.

Unfortunately, you know, there is a, what we call primary school to prison pipeline and there, those things have been growing. You know, we had the crack epidemic that happened in the eighties that really kind of took a lot of the you know, kind of structure of Black families that they had during the sixties.

And now these kids are getting locked up. So now if they had children, those children are growing up without fathers, there are single parent households. And really those are things that generations of people are now starting to kind of see those effects. So hopefully we can change some of these things around because they've really kind of broken up the structure for a lot of people.

Parmvir: Yeah.

Do you know of initiatives that are working on getting more, particularly Black men, into things like medicine and science?

Brandon: Yeah. So we have what they call the Best Program that we work with young minorities. You know, the question that always comes up is when do you try to engage them?

Do you engage people in high school? Do you think, you know, is that too early? You don't do you try to catch them in college while they're already you know, kind of learning about medicines, do you catch them actually in medical school and say, Hey! And I think that's where more research unfortunately is needed.

You know, it's just, we don't know. So there's a lot of different programs out there and each one does it a little differently because no one knows kind of how to do it. And honestly, in my mind, I think as long as we're trying, you know, The effort is there, right. That we really try them all try and high school try and college.

Right. You know, I think having a repeated sense of, Hey, you are important. Hey, you matter, Hey, you need to continue to finish your schooling. I think sometimes really helps propel people. I didn't get to where I was by myself. Right. Like, and there were programs that I were in that my mom signed me up for that I went to on Saturday mornings and I was like, mom, this is the worst thing why are we learning about science on a Saturday morning instead of watching cartoons? You know what I mean? Like, like I didn't get it right. And we don't expect kids to get it, but I think that if the programs are there, the parents will put the kids in them because we know that there's such a need for it. And so and so there's tons of programs out there.

It's just that you know, kind of making sure that we see that it works right. And kind of hanging with the kids long enough that really say, Hey, I like, like, for example, some of the programs that I were in, nobody's reached out to me 20 years later and say, Hey, you used to come here on Saturday. How are you doing now?

You know what I mean? You know, and so I think the longitudinal studies are really what we need, because unfortunately those, a lot of programs don't maintain their funding. And so unfortunately they lose that. And so that's a big problem that we have. So it's, there's, there's layers to this, you know, this is like one of those lasagna's that you see where you have to like, kind of keep cutting through because there's so many layers to unpack, but for sure, I think each little bit helps.

Parmvir: Yeah.

And it's so depressing that those kinds of really important programs always rely on philanthropy and grants and so on. And yeah, it's I completely agree with you, like for most of these efforts we need long term studies of what happens to people when they get out.

Brandon: Yeah. You know, and it shouldn't be, you know, based off of who's in office or we shouldn't politicize some of these things, you know, but a lot of these programs sometimes, you know, depending on what happens in the political climate, they lose their funding. Right. And really you know, kind of, if you, as COVID has shown us, you know, once things shut down, it's hard to get them back up and running, you know? And so that's really what happens. And unfortunately, especially if you take people who are in a very vulnerable community, then it's like, all right, well, if they're not seeing us on Saturdays where they're spending their Saturdays, you know, what's, what's caught their attention now.

Right. And so, unfortunately, Those things just happen, you know? And, and it just creates a perpetual problem. And so I really hope we can see some change and that's my goal in my life to kind of see that, you know, even if we don't, you know, close the gap, at least that we move the needle.

Parmvir: Yeah. For sure. And so we've mentioned COVID a few times already and certainly within our family, David and I, as the scientists we've been called on to answer people's questions, I'm sure you've had the same experience, right?

Brandon: Yeah. So I have family members who texted me pictures of their skin, even though I'm not a dermatologist [Parmvir laughs], you know, Hey, what is this? You know or, you know ask me a lot, you know, honestly, I think it's good that people seek information. You know, there, there are some people who say, oh, I don't even want to look at the internet. And I say, no, look at the internet. I'm here to help you decipher what is important and what's not, but you know, I think that to have a thirst for knowledge and know what's going on, I think that's very important. And so what I did was I used my own personal, like Facebook page and just kind of went live and started like answering people's questions and start talking to people.

And I set up like a, I don't even know if you call it like a COVID questionnaire or a town hall. But I really wanted to make sure that at least people in my circle, you know, people who are my Facebook friends, which, you know, are they really your friends? [Parmvir laughs]

But at least people who I would communicate with and say, Hey, you know, if you guys have questions, I want to be a sounding board to say, Hey what is the New England Journal of Medicine? And, and what is this statistics saying? Like, you know, those are abstract things for someone who may not have been in school in 20, 10 years. Now, you're asking them to read some piece of paper and talk through statistics. That's just not a level of reasonable understanding for the average person. So I said, you know what, let me be the one, read it. And then I'll say, you know what? I got the data, I got the literature let's talk.

And so we were able to do that a couple of different times either through zoom or through Facebook or some platform to kind of make sure that we were able to kind of talk to the masses.

Parmvir: Yeah,

That's amazing.

Brandon: [Laughs] Well, yeah, thanks.

I guess. I dunno. I just, I, I dunno. I just, when you see a need, it's hard to kind of just sit by idly.

Parmvir: Yeah. So did you find that you had particular questions that would crop up regularly?

Brandon: Yeah. I mean, I think the main question is fear. Right. And so people say, is this something I need to worry about? You know, no one wants to die. Right. You know, it's kind of a inherent human right is to live. And so when you see, unfortunately COVID affecting and killing certain groups of people and you're like Hey, that looks like me, you know, the people who are dying, you know? And so I think people really were scared, you know? And so they say, Hey, you know, is there anything I can do to stay alive and be around, you know, three months, six months now, even 14 months since this thing has started.

And so those are the main questions that people want to know, like how do I live? You know? And when the vaccine came out you know, the main question that people had was, Hey, can I trust this? Right? Because unfortunately, trust is one of those things. We have to develop, right. And people is not inherent, you know, that's not something that is just a given that, Hey, you tell me something is good. And I just say, okay, you know, like, you know and so, and so people really have to kind of develop that sense of trust for themselves and we have to be there to be receptive of that.

Parmvir: Yeah.

I saw some tremendous stories on churches within the US and I saw some brilliant like network, mosques in the UK as well.

Like one imam took it upon himself to make sure that he got himself filmed taking the vaccine and so on and made sure that they answered the questions of their local communities.

Brandon: Yeah. Let me give you an example. So I coach my son's baseball team. I did not set out to be the coach.

Actually. I told him this year, I said, Hey son, I'm not going to coach. Cause I typically coach. I said, you know, there's a new coach first day of class. Practice supposed to start at 7, 7:05, 7:10, 7:15, no coach. So you have all these little kids, all these parents looking around, you know, kids starting to get kind of scratchy, you know?

And so it's like, so I said, you know what, let's go out on the field. So I took all these kids. I said, Hey, are you, if you're here for baseball practice, come on. Took all the kids started doing drills started. You know, and so it just took one person to say, You know what? We're tired of sitting around, like we got to get up off our butt and do something and put it into action.

And so I've just taken that upon myself to say, Hey, I'll be that person to do it. And so now I'm like the coach of his team, you know, and that was not my intention, but you know, now I'm this person who is a cancer doctor and talking about an infection or, you know, a disease when really that's not my area, but, but really my, my goal is if I can help one, then that's enough for me and it's worth the time.

And so the kids, you know, they really enjoy the baseball and people really enjoy learning about COVID and really being able to kind of see someone who takes a vested interest in them, you know? Cause I think that's the issue is that people want to know that, you know, they're not just a number.

They want to know that this is someone who really kind of wants them to succeed. And while all the kids, of course may not go to the pros. I'm just like, Hey, I just want to teach you how to throw out a catch, how to do the basics, you know? And so I try to translate that into really everything.

Yeah.

Parmvir: That's so neat. Yeah.

Brandon: But I, I did not want to be the coach. I'll just say that you know, I, I had a long talk on the drive there. I said, I'm not going to be the coast this year. And and yet exactly there was a different plan in place that I did not know about.

Parmvir: Yeah.

David: So I have this question, which is that obviously you wear a number of hats and three of them is like you do: you're an oncologist.

So you, you take treatments for patients. You are a scientist, you do research in a lab and you do outreach. How does the outreach part impact you as a doctor and you as a scientist?

Brandon: You know, I think honestly outreach is one of the hardest things. Because as a doctor, you have really all this medical knowledge, right.

And you bestow that to someone and say, Hey This is the treatment plan. This is your type of cancer, and this is how this is going to work. Right. In research you say, Hey, I have this idea. This is how this idea is going to go. You think of the methods, the research strategy, you know, and you perform it, but with outreach you need to actually listen, you know, and say, Hey, tell me what is going on.

You tell me how I can help. Right? Because I think that's where a lot of outreach goes wrong, is that people still try to convey the same, you know, kind of in the hospital attitude for people who are in the community where it's not supposed to be like that, the community really needs to tell you and say, Hey, this is what we need.

And you need to kind of figure out a way to help them with that need. And so and so it's taught me to be actually a better listener to be a better doctor, I think because like I said, it's just not taught to us that way, it's like, Hey, you know, you've been to school, you know, you've done all this training. You know, tell this person how you can help them, as opposed to being like asking the person, how can I help you and really addressing the person with their specific needs?

Parmvir: Yeah, I completely agree. I mean, it's the same within within science people who are starting to do more outreach work with it doesn't matter what realm it's in.

I guess none of us get any practical training in these things. And so a lot of us are trying to learn to do these on the, these things on the fly. And for me, the way I picture outreach is, like it, it always sounds like it's coming from the expert in inverted commas, out to members of the community. Whereas outreach comes from both sides, right?

If you're shaking, someone's hand, you're both reaching out to each other. And as you say, like the listening component is so important and I don't know how many people enjoy just sitting there and listening to other people. Like they, they're very keen to share their own ideas.

Brandon: Yeah. You know, and, and honestly, if you listen enough, the community will tell you what's going on. Right. But again, that takes time. That takes patience. And, and it takes getting it wrong sometimes. Right. Because like I said, you might just not know. And I think sometimes what I've seen is that people pat themselves on the back and say, oh, you know, we gave this great talk and we did such a good job.

But where's that going to lead, right. Are people really there to absorb that and use the information as opposed to them saying, Hey, this is the information that we need. Can you convey it in a way that we can understand? And I, and I, and I think that's the missing part is kind of doing it from the opposite end and have the community really tell you what's happening.

Parmvir: Did you have any more questions? Yes. David has more questions.

David: We don't often interview people who are physician-scientists.

Brandon: Yeah.

David: So we have a few, but not many. And the first podcast we have a recorded is with my friend Jacob Scott, who used to be based here at Moffitt, but now is at the Cleveland clinic.

And one of the things I remember from working with Jacob is that as a physician scientist, you have two very different personalities. As a scientist, you're supposed to question everything as a physician, you're supposed to project confidence. And I remember my friend just switching from one to the other a bit like code-switching basically, in going from, from doubting everything is like, okay, well, what's the mechanism for this? How do we actually model that? And then getting a call from a patient and switching to I'm a doctor. Trust me. You're in good hands. I know what I'm doing this is great. How do you combine both things? How do you actually do that? It seems impossible to me. Both Parmvir and I just PhDs. For us this is an amazing skill.

Brandon: Well, you know, honestly, I think it's the type of person that you are. Like for me, it's not like I get paid extra to do.

These are things that I want to do. These are things. It has to be kind of in the person to be able to know, to say, Hey, I'm reading this person's body language and they might be looking at me, but I don't think they're understanding a word I'm saying, you know, like those are things that's hard to teach.

And so as a person, you really, that's why having, you know, kind of a a big diaspora of the type of physicians that we have, you know, there's some people who need to kind of be in a lab, they're happy in a lab and they do great science and great work. There's some doctors who kind of can just touch your skin and say, oh, I know that this is the diagnosis and this is how to best treat it.

But then you need people who also are great communicators. Right? You need people who are very empathetic. Right. I mean, there's. I mean, people are not monolithic. Right? And so the different needs that patients need is an array, just like a rainbow. And so we need doctors that are just as colorful and diverse and different as the colors of a rainbow.

And so the problem that comes in is when we try to force the red approach on yellow, it doesn't work, you know? And so So hopefully that answers the question, but really the main thing is I think, you know, having that being the person's personality and that being a part of who they are, I think is, is really the best way to do it.

And knowing the way we do that is if we diversify the medical schools, which will diversify the workforce.

Parmvir: Yeah, for sure. So I'm thinking about you, you're talking about all of the work that you do, and this is all work, you know, you might enjoy doing it, but it's, you know, it takes a lot of time and energy and thought to do these things.

So what do you do for fun?

Brandon: So honestly for fun for me is hanging out with the kids. I mean, that's, that's, that's my biggest thing is that my kids wake me up in the morning. By: daddy, daddy, daddy, daddy, daddy. And, and I, and I enjoy that, you know really being able to like actually coach my son's team, even though I said, I wasn't going to do it, but, but I enjoy it.

My wife probably won't like me telling the story, but our, our 10 year wedding anniversary landed on a Friday, Fridays are when we have baseball practice. And I, and I said, I said, oh man, we need to really celebrate this. Can we do it on Saturday? And she was like, okay. Okay. And so I, you know, just because I really enjoy it.

And and so when, when having fun is what you do for work, then it never seems like work. And so for me even being here, talking to you guys, I mean, this is fun for me. This is a great thing that I enjoy. Being able to share my thoughts and let people know experiences that they may be, have never had and things that people, say oh, a doctor is either talking like that or a doctor, those types of experiences we didn't know. Right. And so a doctor came from what kind of community and so people deal with things that people just are unaware. These are not the sexy things that make the five o'clock news. Right. And so, and so unfortunately, social media and you know, mainstream media really kind of dictate someone's perception.

Like even for myself, I hadn't necessarily seen a black doctor until I was in medical school. And so sometimes, you know, being able to see things, help people be able to achieve it and attain it. And so that's my role and that's my, my mission in life.

Parmvir: I love it. Love it. Like I said, I mean, essentially it feels like you've just got to do the things that bring you joy.

And if hanging out with your kids and doing your work is what brings you joy that's...

Brandon: yeah, yeah. I won't tell them that because sometimes they, you know, daddy, daddy, daddy. I'm like, oh gosh, here we go. But but it's, it's all fun. My son is seven and my daughter is four. So, so they're very lively and energetic.

So they keep me busy.

Parmvir: I think that's exactly the ages of my sister's kids seven and four. Yeah. They're fun ages.

Brandon: Yeah. Yeah. It's fun. And that's, I mean, that's, I mean, so people say, well, what do you like to do? I was like, whatever we do, we do well, you know, so I hate to say it like this. So in our neighborhood, I'm now the Baseball guru.

So now all the neighborhood kids, like, you know, we every night almost they go out and say, Hey, let's play baseball. And so they have me being the pitcher and all this kind of things, but I just, you know, I enjoy that. Cause I know that at one point at seven turns to 17, they won't want to hang out with dad anymore.

Right. And so I really try to soak up this element.

Parmvir: So, did you ever use to play yourself?

Brandon: I did, but not, well [he laughs], I you know, football and basketball were my two main sports. I actually tore my ACL in high school playing football. And so I told myself, I said, I'm having surgery to have fun in a sport and I'm 15 years old.

And I said I think I'll just stick with the books. And so, and so I still enjoy sports and they're a great way to kind of pass time and kind of keep in shape. But but I knew that my kind of career trajectory was something else. I'm here now.

Parmvir: I'm sure the medical profession and the community is much happier for it.

Brandon: Yeah. They, they weren't happy for my sports skills. I'll just say it that way.

Parmvir: Well, thank you so much. We really appreciate your time. It's it's been very educational for us. It's, it's amazing to hear about the work that you do. And I think it's just so very important.

Brandon: No, thank you for giving me the opportunity to talk.

Like I said, health disparities research, again, isn't one of the sexy items that kind of makes the cover of really any research magazine. So to let people know that, Hey, there's people out there who are trying to understand why, you know, one person who doesn't make as much. Doesn't do as well as someone who's rich, that shouldn't happen.

Why does someone who looks different on the outside have a different biology of their disease on the inside? We don't know. And so there's someone who's trying to answer those questions. And and it's not just me. We have a whole team of people at Moffitt but also across the country. But unfortunately that circle is small.

And so hopefully by sharing this with people, they will know that this is something that you can make a career in. And it's something that really is very needed.

Parmvir: Yeah.
[Musical interlude]

Brandon: When I was in medical school, like the first day of medical school, everyone's kind of like meeting each other and meeting all the teachers, like, you know, that kind of thing. And still, I hadn't, like I said, really seen a Black doctor, so I kind of knew that I was in medical school to be a doctor, but like, it hadn't like hit me that like, Hey, you can actually do this.

Right. So there was like an intermission. I went to the bathroom and one of my teachers was there, you know, as guys know, you know, you never stand next to the guy in the stall. It was always this kind of awkward. And he ripped literally the loudest fart that I have ever heard. And for some reason that fart made me think, oh, this guy's just like me.

He farts, like, you know, and so I said, I can do this, you know? And so that, that was the light bulb moment for me, where like, I guess I'm going to be a doctor now, you know? And so I won't say his name, but I appreciate you and your fart really shaped my career. So that is my great story.
[Musical outro]

Parmvir: Your career is predicated on flatulence.

Brandon: Love it. Love it.