Dr. Raza to bring the patient back front and center into every conversation about cancer. To look at everything we are doing in the cancer paradigm through the prism of human anguish. And let everyone see what are the human costs of pursuing cancers to the last. Susan your book readers will find an interesting mix. It has poetry, patients stories and a lot of technical and clinical analysis in it. What were you thinking . Who is your intended audience . Dr. Raza it was not so much the audience but the way i was trying to tell the story. First, i was only going to write about my patients with nothing personal but once i told the stories in deep, granular detail, i felt dishonest holding back my own. Somehow, there was a level of insincerity in going into the depths and profundity of patients feelings and anguish of families without talking about my own. And then i started thinking about my own. Susan what does poetry do for you . Dr. Raza yes, i felt a cleavage in my mind as if my brain was split. I tried to match it seam by seam but could not make it fit. One thought joined to the thought before. A sequence, out of reach like balls around the floor. Why did these few lines speak volumes to me . Because when i am facing a patient, whether it was my own husband who was at the Cancer Center and in a cruel twist, he was diagnosed with the cancer that he had spent his life fighting since the age of 15 or whether it was sitting across an examination room from a total stranger who within 20 minutes will be telling me the most intimate details of their lives. When i hear those, i feel my brain is split in two because on one hand, i know pretty much what is coming their way by listening to their stories. But on the other hand, there is a wonder about the essential mystery of this individual sitting in front of me. What will their journey be like . What obstacles will they meet . And my brain was split. As Emily Dickinson describes. When you ask me what poetry does for me, i come from a deeply oral culture. The oral tradition is such that as long as we can remember, we were made to memorize poetry. Because, two lines of poetry called a couplet like two strands of dna. Within those 25 words or less is a macrocosm. The same way a few thousand strands of dna can create a protein or a sperm or an egg into what their natural existence should be. To me, there are great parallels between science and poetry. Between the double helix of dna and the lines of poetry. Susan what exactly is cancer . Dr. Raza cancer is the immortalization of a cell in simple words. It is freedom from growth controlling signals either from within itself or outside of itself. Unchecked growth for no essential purpose that it is serving except its own purpose of continuous proliferation and division. That is what we call purposeless growth and malignant growth which can set up killing itself along with the host. Susan how many kinds of cancer do we know about . Dr. Raza hundreds. And within each sorry, within each cancer there are hundreds of cancers that exist. There are infinite variations. Traditionally, we classify cancers as belonging to an organ. A breast cancer, an ovarian cancer. But there is molecular, genetic, fundamentally cellular levels. There are cancers associated with a certain genetic mutation for example. Whether it exists in the lung or the kidney. That genetic mutation could cause a cancer in each organ. We will then classify a cancer not on the basis of organs which would be selflimiting but on the basis of fundamental biologic characteristics which would lead to a variety of cancers, ad infinitum of cancers. Susan and therein lies the challenge. Dr. Raza therein lies the challenge. Susan have scientists identified the trigger point that starts the initial mutation . Do we know if it is in society or the body what starts the process . Dr. Raza it is interesting that when you trace the history of cancer which my colleague at Columbia University has done. If you look at the history of cancer, you can go back millennia and find malignant growth being discovered. And the word cancer was associated with malignant disease and what has happened to understand the origin of this very strange, alien sort of growth in the body. And only once the code for the dna was finally understood and biology morphed more towards a reductionist approach of molecular biology and then understanding genes, all of these things combined together finally began to shed a light on what really is happening at the molecular level inside these cancers. And that is when it was realized that no matter what the fundamental cause of the disease is, eventually, what has gone wrong is the messages coming out from the genes that are controlling either helping growth or suppressing growth. Something has gone wrong with one of these two types of signals within the cell. Not only is it fairly well accepted that cancerous growth is a result of the malfunctioning of the genetic messages. Susan things can trigger those malfunctions like smoking or other causes are external . Dr. Raza a third of lung cancers can be directly attributed to what we call the exosome. It is in the collection of transcribed dna that can change into a message. The message is carried to the proteins. A collection of that kind of dna is called exome. It is not just the exome. It is seed and soil that have gone wrong. Susan how pervasive is cancer . Dr. Raza a lot of numbers are thrown around but one in two men and one in three women in their lifetime will be faced with this growth. Susan how curable are they . Dr. Raza this is the good news that today we are curing 68 of the cancers that are diagnosed. Who wouldve imagined that one in two men and one in three women would face cancer . The first is the population is aging and cancer is a disease of older age. The more older people, the more cancer will occur. And secondly, we have learned to detect cancer earlier and earlier. We are finding more and more cases now. It is not as if the incidence of cancer is increasing that because the population is living longer and because of Early Detection, that seems to have gone up. You asked me if this is an automatic death sentence it used to be. The stigma associated with it. But now, we are curing practically 70 of the patients because of related section and because of the other main reason which is the antismoking campaign. Going back to your point about exposure. These are very important things because of the rich lives being saved. Susan that seems like a lot of good news so where is your frustration . Dr. Raza on the surface i should be proclaiming victory from the rooftops right now that we have gone from basically a universal death sentence as you said to curing 68 of cancers today. Only 32 of the people die. I ask a fundamental question. The people we are curing, 68 , my frustration is why are we still using the approach of slash, and burn . Why are we not finding better ways of treating cancer instead of poisoning it out or burning it out . Pediatric oncologists are forever thumping themselves on the chest. Look it what you are doing to the children. 20 80 of them will end up with problems that will make life very difficult for them. Why . Because look at what we are doing for them. The second issue of the curable population is that susan, do you know that one in five new cancers appear in cancer survivors . What is the reason for that . One reason is that whatever caused the first cancer is still there but a second one could be look at what we did to them. How much did we create by giving them poisons . Did that also contribute . That is my one frustrations. If research and all of this influx of hundreds of billions of dollars in 50 years with hundreds of thousands of the most Brilliant Minds in the world working in this area have only come up with treatment that still rely on those stone age strategies, what is the use of this research . Arthur miller, the great playwright, said something which has always stuck with me. Which is if today does not offer justification for hope, then tomorrow is the only day worth investing in. Today, if all of this money, all of this intellectual focus and attention has gotten us no other better than a few except for a few cancers from which targeted therapies dont depend on these cures, on the other hand, there are people for whom the diagnosis is not a death sentence. That would be bad enough. What do we do in that final terminal moment . That itself is something that is cause for us to pause and really think deeply about what we are doing. The primary rule of medicine is first, do no harm. What are we doing to these 22 of people for whom we know from the moment of discovery their chance for a cure is 0. 00. Susan why has the system not responded . Why do they continue to use these methods . Dr. Raza first of all, it is not for lack of trying. We have all been trying to develop new strategies. It is always easy to look back in hindsight and start pointing fingers but the first person i point a finger at is myself. What have i been doing . I have been on the front line of this whole paradigm for years. Where are my solutions . And, a couple of reasons for it are i dont want to go into a personal thing right now but i wanted to answer in a more general way why has Cancer Treatment failed so spectacularly to come up with a new solution . We pin our hopes on something for a decade and then we go on to the next fashionable cycle and i have lived through multiple cycles of great excitement followed by crushing disappointments. I will give you an example of this. In the late 1970s, early 1980s, it was all about the oncogene which is a normal gene present in our body and animals found to cause cancer in them. We realized we were getting genes that can cause cancer within our bodies. Changes in their control. We knew there was so much excitement that once we find the gene causing pancreatic cancer or others, we come up with an antidote and the solution should be easy once we have found a gene. Almost a decade to do more research but it turns out that the oncogenes are not that easy a target because in any given cancer, there are mutations in the given oncogenes. They need a lot of nutrition. How do they get nutrition and make new blood vessels . Why dont we choke off their blood supply and starve them to death . That became the holy grail in the 1990s until we discovered that we were very successful in curing mice with this approach. There are a lot of healthy mice running around new york because of that but when we tried to translate it and bring it to the bedside, it was a spectacular failure but for a couple of cancers. Mainly, that approach failed. And then we pinned our hopes on sequencing the human genome. Around the time it was sequenced, there was treatment for chronic milo leukemia. There is a chronic and stable phase. If the patient that can be targeted with one drug. This was done and this became the most successful treatment of a cancer with a targeted therapy. It grows to be a little bit of a disservice to the rest of the cancer field. Because we believe that now all we have to do is find that one gene that causes the one cancer in each organ and target it too. It turns out that no, the actual cancer cell that exists in let us say an organ like the lung or the brain or the pancreas is a moving target. It is constantly picking up new mutations each time it divides. It makes dna editors. Because cancer cells are dividing so much more rapidly, they pick up more and more mutations. Each time a cancer cell divides into two, it is making potentially two new cancers with new mutations. The complexity of cancer comes mainly from an inability and our inability to develop new therapies is because it is a very complex disease. Within the cancer cell, the signal is more complicated and distorted and intricate than the trafficking of the london underground. And it keeps changing because it is acquiring new mutations. The disease is so complex now, trying to understand it at the genetic and molecular level every single signaling. It would take a thousand years to come up with a solution and it may never be a solution for that unless we catch it when it is just starting and kill it. Susan as a lay person listening, the argument should be that researchers should continue to pursue other avenues then just those that are being investigated. Is that an interpretation of what you just told me . Dr. Raza i think that would be a harsh interpretation, susan because along the way we may be failing our patients but we are rarely successful in understanding the biology of cancer. Which is going to help the patient in the end. I am just saying it will take much longer. I wouldnt say it is always a death sentence at all. There are they have shed dramatic light on to our understanding of how cells divide. How life happens. How aging happens. It is dramatic and spectacular. The problem is none of those things have been translated into proven therapies for our patients. That is my frustration. Im not saying that this is wasted effort and money. Absolutely not. What i am saying is that and we have current patients. We cant just worry about the future. We have to worry about who has cancer now. All im saying is that my frustration comes in fact, one of the things you pointed out was why not take off our blinders and see the situation for what it is . And we need to keep understanding the biology. How should we progress in the area . On the other hand, that approach will not work for our patients that we have right now or who are coming in the future. And try to reallocate the resources so is least in the future we avoid these kinds of end stage patients that we are seeing. Susan your patients have less of a chance of surviving their disease. Tell me about what you treat. Dr. Raza i began my career actually because i have been interested in biology all of my life, since i was a kid. I started becoming a serious oncologist. And then evolution really caught my attention and i became deeply occupied by this concept of evolution by natural selection. And that led me to seriously start looking at embryology and how life comes into existence. And i wanted to become at six or 17 years of age, a molecular biologist. But in pakistan where i grew up, we did not have such an opportunity for postgraduate studies at this level at least. My only entry into science would be through going into medicine. And i reluctantly went into medicine thinking i would finish my medical education and then move on to what i really wanted to do in the lab. Except when i saw the first patient. That changed my life forever. As i knew that from that moment on, i could not look at anything except through the clinical glasses that had been provided to me. The suffering of patients and how urgent it is. And that keeps coming back to me. I will give you an example. My husband died after almost a fiveyear long battle with cancer. He was diagnosed and our daughter was four years old. When he died she was eight. Eight and a half or something. After he died, a few weeks later, my daughter who was eight years old got the flu. A really nasty one. After almost a week of suffering, she started to improve. One morning i was in the living room working early in the morning and she came out of her room sobbing. Every mother is immediately convinced that she has had a relapse and something is terribly wrong. I rushed over are you much worse . And she was inconsolable. Once she was calmed down a little, this is what she said. Actually, mom, i feel much better today. I feel totally fine. But now i know what it means to be so sick and how good it feels to get better. And my dad never got better. That is the kind of moment that makes you realize what real suffering is all about. This child, eight years old, who experienced this, the sudden insight. I felt like my eyesight and intellectual interest were suddenly given an insight by interaction with patients and direct experience of disease at that level. Once i got interested in cancer, basically, i had a choice between two things. Study a solid tumor or a liquid cancer. And why i chose the liquid cancer was because that in a solid tumor, let us say there is a tumor in the long and i wanted to study it i would have to rely on surgeons to cut it out, give it to me and god knows what small part i would get. I would have to segregate it. So much artificial things happen to the tumor. And secondly, i want to study it again and another tumor arises and it is not the same as the first tumor. Solid tumors to me were a very difficult challenge from the perspective of an investigator. On the other hand, in a liquid tumor like leukemia, cells are circulating throughout the body and you can put a needle in and get as many as you want. Or get a bone marrow biopsy periodically. And you can monitor this before, during, or after therapy you can study them as many times as you want. It became much easier to study in the lab. For all of these reasons, sorry to give you such a long answer, but the science, the obsession i had with the disease it comes because this had been developing since i was very young. And there is a method to the madness that took me to this unpronounceable disease according to my husband mylopdisplastic syndrome. Once i began to study the liquid tumors i began to study acute mylopdisplastic leukemia. I began studying and treating this kind of leukemia. In 1977i began studying and treating this kind of leukemia. By 1984, it was apparent to me beyond a shadow of a doubt that this disease was so complicated that in my lifetime we would not be able to cure it. Anyone that gets cancer, the best news you can get is that it was diagnosed early so they have a good chance of a cure. If Early Detection was the only chance of cure, i began to Pay Attention to my patients that would give a history. Six months or a year they had low blood counts. And that was called preleukemia. Why didnt we catch it then in the earlier stage, preleukemia . Why did we let it become this kind of terminal rapidly growing, aggressive disease. I turned my attention to study preleukemia and following those patients. You asked me what kind of cancer am studying . I began to study this kind of leukemia because it was a liquid tumor. I ended up focusing my attention more on the preleukemic disease which is called mds for short or mylopdisplastic syndromes. Although one lady said it stands for my disease stinks. That is what i study now. Susan how often in your profession do people treat and research . Dr. Raza rarely now. There was a time when we could do both. But the Knowledge Base has expanded so much now that it is literally impossible to do both. But i am one of the oldtimers, lucky me that gets obsessed with this. I say if im given 72 more lives, i will do each time the same thing in honor of my patients. Susan your book told the story of a number of those. I wanted to show a video of one that you referenced briefly. This is julia williams. We will watch a little video and talk about why it is important to hear the stories. Lets watch. [video clip] i found there was a real absence of truth about living with this disease. When i started writing, i vow i know this is really depressing and dark but i swore i will always be honest with you my readers. There is a lot of anger and jealousy and bitterness. A lot of fear when you live with this diagnosis. Once i started writing about it, it was like i felt free. I no longer carried that burden. Fighting with my freedom is my freedom. Susan we learned that julie died on march 19, 2018 at the age of 42 what she told her story all along the way. And you tell other stories. Why do you want the rest of us to hear the stories . Dr. Raza i think hearing them is the importance of the subtitle of my book the human cost of what we are doing is so important to me and they can only be it can only be illustrated in the depth with which we need to see them if we follow what happens to patients with the Current Treatment regimens that are given. And that was my reason. If we are going to tell the story of cancer, we have to see what it is doing to people who are young. Andrew was 22 when he was diagnosed. Another was 38. My patient, jc, was 34 when she was dying. On the other hand, harvey was diagnosed at 57, my late husband. Other patients are in their 60s, 80s. There is a patient in the 90s. There is no age immune to cancer. The book, of the seven chapters, only three are younger than 40 years. The others are all older. At every level, there is a different kind of suffering and pain these patients experience. And not just the patients, but the cost to their families. One of the unique things that this book allowed me to do was to go back to the families after a certain length of time from when they lost their loved one and ask them to cast a backward glance and now, question the decisions that were made, the choices given to them. Would they have altered anything . What kind of what does that kind of perspective tell us about human suffering . Was the denial of death on their part. Susan when someone receives a diagnosis of the kind of cancer that you treat, what other option is there besides the ones that you call slash and burn . What could they do other than that . Dr. Raza for most common types of cancer, very little. As i said, there are some cancers that are targetable with different new therapies. For example, chronic milo leukemia is targeted by a drug therapy. Most of them are just palliative rather than curative. They help a fraction of the patients for a limited amount of time and then that is it. What a patient can do besides the traditional approaches that are given . Very little. Even though those who can afford it will keep going from one oncologist for a Second Opinion and a third opinion and from one big Cancer Center to another with the hope that somebody might offer them a hope. There isnt any. Susan when you describe the choices, i guess it is a question about what you learned from the families when talking to them afterwards what did you learn from the families experience . Dr. Raza i mean, it is not just what ive learned from these patients. See 3040 patients each week. What i learned on a daily basis is that this is not unique to me. We learn all the time from every day of our lives when we are interacting with patients. And with each patient, there is a split in my brain. At on one level, i know what to expect. At another level, something is completely unexpected. The one thing i have learned is there is no oncologists that i have met in my lifetime that did not care for their patients. And no oncologist i know has a simple algorithm that they follow with everybody and get the same answers. What ive learned from these patients is importantly, you can never take away hope. But that optimism has to also be combined with the pessimism of the intellect. Understanding the gravity of the situation. But somehow not taking away hope. Harvey, my late husband, was the head of the Cancer Center. One of the most knowledgeable people about cancer in the world. And he gets leukemia and now we see something on his chest xray. We see there is no question. How many fungal infections has harvey treated in his life . And yet, he would turn to me at that moment and they help, what do you think . Because he allowed me to decide how he should feel and react to this menace that is appearing. That we both know what it means. And yet, i took Infinite Care not to break his spirit. And that is what patients have taught me all of these years. We cannot take away hope. We cannot break their spirit even while recognizing full well what is in store for them. Our job is to help them face it as well as deal with it on a daily basis. And spend as much time as we can with them helping them do it and not hand them over to some hospice care. Susan you write about not just the emotional cost of this but also the enormous financial burden that the treatment has. Can you talk a little more about what this does two families financially when they face a major cancer diagnosis . And what Options Society has for that . Dr. Raza yes, i can say it in one sentence it is the whole entire market side of this cancer paradigm is on the verge of collapse. Because, not just the physical and emotional burden but the financial burden is such that 9 million newly diagnosed Cancer Patients were looked at and followed for a period and studies show that 42 of Cancer Patients in America Today 42 become completely ruined by two plus years after their diagnosis. Susan financially ruined. Dr. Raza they lose every penny. And no one is cured. What does this mean . It means that not only they are ruined but the next generation is ruined. The financial ruin is reflected in everyone in the family. Susan is this a statistic that is endemic to the United States only because of our Health Care System . Does the same financial ruin exist in other countries . Dr. Raza i dont know much about other countries. I know one thing that everyone looks to america for leadership. I mean i can quote numbers like we spent 27 more for capita on health care in america than we do in other developed countries in the west. I dont know what these statistics mean. We do spend a third more than other countries but we do offer a lot more things. And we do see our patients immediately. There are other problems that other countries are facing. I do not feel confident about expressing an opinion on this except to say that everyone is looking to us. Susan the paradigm is that the Cancer Treatment costs a lot because the research that goes into developing the treatment costs so much. Is that correct . Dr. Raza it is not that simple at all. Susan why is it so expensive to treat cancer . Dr. Raza if you read stephens article, an extraordinarily long piece that basically, highlighted the various levels at which our Health Care System is failing us financially. It is very easy for example in cancer to point at pharmaceutical companies and say look, this drug, this developed drug xyz is prolonging the lives of pancreatic Cancer Patients by 12 days but it costs 26,000 a year. What kind of insanity is that . It is easy to point at that. And conveniently it targets pharmaceutical companies. But if you go to buy 100 tablets of tylenol at the drugstore, you can get them for less than five dollars but if you are going to be admitted to any hospital, whether it is a Small Community hospital or a big Cancer Center, you could be charged two dollars for one tablet of tylenol that you take. A bandaid you can purchase 100 for 3. 99 but if we put one on you in a hospital, it will cost you 50. Why . We cannot keep blaming pharmaceutical companies. Why are hospitals charging so much . Why are nonprofit hospitals the biggest ones are nonprofit and yet they make a profit of hundreds of millions of dollars a year. Where is that profit going . They dont have shareholders. And then they purchase more practices and hire more business people. This all keeps driving up the costs and the biggest cost . Is also because of the fact that the way the Research Works right now to develop new drugs for cancer for example, it works Something Like this. The National Cancer institute for and grants individual investigator like me to work in my lab and identify a protein or pathway that i think will be a good target for attacking this cancer and getting rid of it. I am funded by the National Cancer institute. I find this. And i show that this drug works in petri dishes in stopping cancer here. But now, i have to try it in humans. Before going to humans, i will have to try it in two mammals first. Which our animal models. And then, once i bring it to trial, the phase one trial will cost 50 million and phase two will cost 150 million. Phase three will cost 500 million. By the time we go from and that kind of money cannot be invested in me by the government. Or the National Cancer institute. So now, the pharmaceutical companies will step in and take over the target for me and take it to the next stage of development. They will end up spending anywhere from 1 billion up to 2. 7 billion and take two years to develop this drug. They bring the drug. 5 is the proven rate. 95 of drugs fail by the bedside in phase three trials. Today in cancer. So, why are companies and people ready to invest billions of dollars and decades of work into an enterprise that has a 95 chance of failing . Why . Because if one of the drugs is approved, they will make millions for years to come. And then the institutions like the fda and the nih which are supposed to protect us, now have lost control completely. They have no say about the prices that are set. It is such a complicated system that has evolved over the last three or four decades that it is very difficult to identify any one thing. Like is that the research where the money is being wasted . Is it the Clinical Trials . I think it is a combination of things but it is untenable and unsupportable and on the verge of collapse. Susan getting back to the patients. Is there a point at which the doctor involved should give them a choice between two paths that you can go forward with this treatment but it is likely to do this to your body or you can choose a Palliative Care . Do the systems do that well enough and often enough . You talked about what it does to the body and the enormous expense and the emotional toll . Is that process working as well as it should . Dr. Raza the big cancers advanced disease has to be dealt with. Where the outcome is very negative and we know it. But then, even their occasionally there will be anecdotal survivors for much longer than we expected. Basically, it is hard to tell a 22yearold that you will either die of cancer or die of the treatment we give you so now choose. The mother of andrew would always say even if there is one , in a billion chance, i want to take it. One of my best friends would say anything. And she lived in a fog from the moment of discovery that he had cancer that she entered this state where she was not willing to hear anything negative because that would cause her to collapse. And she would not be able to even you dont register this consciously but this is what happens. The choices we give to our patients are spelled out in fine print on consent forms that are 50 pages thick. But the only thing that patients will read is the one possibility that they will respond. They keep saying this about patients. They concentrate on what gives them hope but oncologists do the same. When we talk to our patients, we tell them the negative things that can happen but we also stress that one possibility even if it is a small possibility. Look come you could be one of the people that get well. Invariably, the majority will choose that over Palliative Care. What do they have to lose by trying . Susan and they dont know what they have to lose because they dont know the extent. Dr. Raza that is the problem. You said it very well. They dont know the physical or emotional toll. The toll to the family, and the school burden. Fiscal burden. Susan we have about 10 minutes left. Let us move to the communitys reaction to you speaking about this. How have you seen this in the Oncology Community . Dr. Raza i am dramatically welcomed. My colleagues that wrote the emperor of all maladies was my interlocutor. He said what you are showing is that the emperor has no clothes. And he is an authority on the history of cancer. Which he has told beautifully in the emperor of all maladies. My colleagues across the country have been so supportive. Everywhere i have gone and i have gone on my book tour from washington, d. C. To connecticut to seattle to San Francisco and portland. People who have interviewed me are extremely wellknown and wellrespected leading oncologists and scientists in the country and everyone agrees with me. There is a level of frustration and all of us dealing with cancer. It is not just me alone. And it is not like im saying something new. Really, we knew that Early Detection of cancer is the best protection against dying with it. Early detection and treatment. What i am saying is that why are we still using very old techniques that were developed 50 years ago for Early Detection like mammograms and colonoscopies . Imagine putting a tube into look for cancer in this day and age of technology. Where we host of cutting and pasting dna like gods. Why are we using these kinds of things for Early Detection and say that Early Detection does not work every time. No, what im saying is it is like the moonshot where you bring all of your faculties to bear. All of your technologies to bear. And you use this kind of new age technology. The next generation of devices and scanners and biomarkers, proteins that can be made into a barcode that will be pancreatic, ovarin, brain cancers all in a room and youll have it on a chip and the chip is inserted under the skin and automatically, a small device like your phone can do tech the earliest footprints of a cancer cell. Why are we not investing in that kind of thing instead of constantly using the same old same old, chasing down cancer to the last cell even if the patient dies in the bargain . Susan where is that kind of approach likely to come from in our society . Dr. Raza it is already happening. No one can stop this revolution now because pretty much all of health care is realizing that we have not found the cure for much. The most important cure we have ever found in medicine is for the Infectious Diseases with antibiotics that doubled the human life. More than antibiotics, what happened in Infectious Diseases is vaccination and prevention. We dont talk about polio and tetanus and rabies and small pox anymore because they have waived those things out a sickly. And that happens because of prevention. So, we know that even in the Infectious Disease where we have such cures for stroke or diabetes or high Blood Pressure we dont have a cure unless we go in and fix the arteries. Cardiovascular deaths have been brought down by 70 , again because of Early Detection and fixing it, preventing it from becoming a heart attack. My colleagues around the country are very supportive of this idea. All of health care becoming aware that the future of health care depends on Early Detection of alzheimers disease, parkinsons disease, cancer, Early Detection and prevention. And prevention not just by Lifestyle Changes but by actually proactive prevention where you go in and attack the biomarkers. Dont rely on anyone test. Do 50 tests. If i detect the first cell of pancreatic cancer in my body from a liquid biopsy from the blood, i now need to confirm that from scanning devices which can scan me in the shower or the sheets that i use overnight that can image whether there is a hot spot in my pancreas or not. Biomarkers detected from tears and saliva and sweat and urine and stool. And when we brush our teeth. There is a part of the saliva taken and tested. All of these things together, when they are combined suggest that there is a potentially lethal presence that is growing, that is when we can move and use targeted therapies that are failing in end stage cancer can work in early cancer. Susan you are hopeful . Dr. Raza the book is about optimism and hope and about looking toward the future. But by telling the stories of what is happening now. The purpose of telling these painful stories is not to revel in pain and suffering is to liberate us from the past. To liberate us from doing these things are again and again. To have a forwardlooking, imaginative, more exciting approach which is less painful to the patient and less expensive. I will end this part of my answer by saying that just last week my younger brother who lives in italy now and who runs this amazing website to which we have been posting and linking stories for the last 15 years every morning, he sent me a link to a story which is pointing out that the japanese have just developed the test from one drop of blood which and attacked which can detect early markers of 13 different types of cancers which you can do at home which will cost 180. This will sound like a pie in the sky story but these are actually seriously happening now. It does not mean that the technology is a failure. No, the technology is being developed. There is no escape from it. We are Going Forward with it and this is how the future will be. Invention and Early Detection. Susan we ended on that. Azra raza, thank you for spending this hour with us. Dr. Raza thank you. Announcer all q a shows are available on our website or as a podcast. At cspan. Org. Announcer next sunday, former wall street trader turned photojournalist chris discusses his travels documenting the plight of People Living on the margins of society in america in his book dignity. That is next sunday on q a. Is agreed to. Or amended is as ordered. Two articles of impeachment against president trump. House rules committee will meet to determine the guidelines on how the debate will unfold on the house floor. Watch live coverage tuesday at 11 00 a. M. Eastern on cspan3. Watch online or listen live with the busur cspan campaign 2020 team is traveling across the country asking voters, what issue should residential candidates address . One of the issues i really wish the candidates for 2020 would talk about more often is the issue of Mental Health. It has been a controversial topic the past several years, and politicians may say we are going to do this or that, but i feel like not a lot is being done about it and it seems like nobody is talking about it as much anymore. I would like to see that issue have more attention again because it is a very serious issue that is plaguing millions of families all across this country and i would like to see peoplealth programs help afflicted with unfortunate Mental Health problems. One of the issues that are close to heart for me is immigration. I would love to have candidates become the topic of immigrations and immigration reform, and the current climate of immigration in the country. That is something that surely has to be addressed. Factnnot just hide the that there are issues that need to be addressed when it comes to immigration