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Speaker 2: Hey Ologites Ali Ward here. So blood it's important. It's
Speaker 2: kind of scary and you yourself are a pulsing, barely
Speaker 2: contained leather sack of it but what is it? In
Speaker 2: this episode, we'll talk to a hematologist slash oncologist about
Speaker 2: what blood does and why he works with it and
Speaker 2: what can go wrong and how to fix it. And
Speaker 2: before we dive in, I want to say thank you
Speaker 2: so much for the five hundred review mark we hit
Speaker 2: on iTunes. You guys, I appreciate it so so much.
Speaker 2: I read every review like total creep and it really
Speaker 2: keeps me going. So I'm going to read you my
Speaker 2: favorite review this week. Do you want to hear it? Okay?
Speaker 2: See Magnus said, I'm afraid of death, birds and the universe,
Speaker 2: and the episodes about these topics were so interesting and
Speaker 2: engaging that I forgot these things terrified me while I listened. Yay,
Speaker 2: she said, Ali is a great host who really knows
Speaker 2: how to keep a podcast flowing in an entertaining way.
Speaker 2: Very impressed. She records her parts from a closet. I
Speaker 2: am in a closet right now recording this life. Also
Speaker 2: a jello Ze said, I want Allie as a friend. Done, Donzo,
Speaker 2: We're pals now, they say, great podcast. I even enjoyed
Speaker 2: ologies that I thought I was not very interested in.
Speaker 2: Can't wait for more. I always love hearing that. When
Speaker 2: someone's like, I didn't think I'd care about this, but
Speaker 2: it was a good episode, I'm like, yes, we did.
Speaker 2: Thank you so much for leaving those reviews. They help
Speaker 2: so much and they really get the show seen in her.
Speaker 2: So this episode hematology comes from the Greek for blood,
Speaker 2: pretty simple, and I learned about this particular ologist through
Speaker 2: a blood relative, my pop. So a few months ago,
Speaker 2: my dad forwarded me an announcement for a charity function
Speaker 2: in LA that was a comedy show with some comics
Speaker 2: that I'm like familiar with like Kamil nan Gianni and
Speaker 2: Hannibal Barres, Mark Maron, Ray Romano and Nicki Glazer, all
Speaker 2: these people. I was like, WHOA, how did they all
Speaker 2: get involved in this? Well, there's a blood cancer called
Speaker 2: multiple myeloma, and Peter Boyle, who played the dad on
Speaker 2: Everybody Loves Raymond, battled it for a number of years
Speaker 2: and every year, in partnership with the International Maloma Foundation,
Speaker 2: his amazing family puts on this comedy benefit to raise
Speaker 2: money for research. Now, my dad also has multiple myeloma,
Speaker 2: so I reached out to IMF to see if they
Speaker 2: needed some volunteers, and I got involved with a benefit
Speaker 2: that way, and was really lucky to be able to
Speaker 2: take some time of one of the lead researchers in
Speaker 2: this field before the event and get him in a
Speaker 2: conference room and pepper him with questions about what he does.
Speaker 2: He was so nice. Now, usually I have listener questions
Speaker 2: from Patreon supporters, but today all the questions are furnished
Speaker 2: courtesy of mister Ward, my dad, who is kicking the
Speaker 2: ass of this particular blood cancer. So when my dad
Speaker 2: was first diagnosed in twenty thirteen, I didn't know anything
Speaker 2: about blood diseases, even though thirty thousand people a year
Speaker 2: will be diagnosed with multiple maloma and my uncle also
Speaker 2: had it. Now, when my parents found out, I'm not
Speaker 2: sure if anyone else who has been affected by any
Speaker 2: kind of illnesses has done this, but the words multiple
Speaker 2: maloma were written on a post a note and given
Speaker 2: to them by like a nurse to go home and google.
Speaker 2: The prognosis at that time was two years, and I
Speaker 2: myself curled up in a ball, honestly like hoarsely cried
Speaker 2: for a few days. Now it's five years later. My
Speaker 2: dad is still doing well, and they have this now
Speaker 2: faded pink post it note and its taped to their
Speaker 2: computer desk as a reminder of those first really terrifying
Speaker 2: months and also of a lot of hope. And at
Speaker 2: this comedy benefit, a lot of the comedians I talked
Speaker 2: to had to google the disease. Some on the car
Speaker 2: ride over they were like, Oh, I don't know what
Speaker 2: it was, which is totally fine for my family. Personally,
Speaker 2: these words are on our minds every day, and the
Speaker 2: people who are getting up and going to work to
Speaker 2: find cures for this and other diseases are like celebrities.
Speaker 2: They're amazing. So here's the d When you work at
Speaker 2: a coffee shop, you probably get good discounts coffee. With
Speaker 2: my work, I have access to so many science heroes
Speaker 2: and getting to sit down and interview someone who's the
Speaker 2: front lines of this is a pretty big perk of
Speaker 2: the job. But I struggled with whether or not this
Speaker 2: episode would be relatable, and some of their nitty gritty
Speaker 2: about treatments I cut. So if anyone, especially if you've
Speaker 2: been affected by multiple malomo, wants a copy of the
Speaker 2: uncut version, email me at Hello Ali Ward at gmail
Speaker 2: dot com. I can also post it on the Patreon
Speaker 2: page and I'll just give you the full version with
Speaker 2: all the nitty gritty. So I've shaped this episode to
Speaker 2: be all about what is blood, what's the healthiest, most
Speaker 2: scientifically chill way to live? What is cancer? How can
Speaker 2: we make ourselves less vulnerable to cancer? What therapies are
Speaker 2: being developed? How many people attend Coachella, what brought theologists
Speaker 2: to this field? And the etymology of some Cantonese slang
Speaker 2: involving fish. And I can say I walked away from
Speaker 2: this interview feeling so hopeful about my dad's prognosis and
Speaker 2: also more empowered to take care of myself. Well, I
Speaker 2: can it's so easy to treat your body like garbage
Speaker 2: and be like I'll get help you later, or I
Speaker 2: don't like deserve to rest. I got a hustle. But
Speaker 2: once you find out how much my dad's chemotherapy costs
Speaker 2: each month, you will take a nap so hard and
Speaker 2: you will only eat like spinach and walnut smoothies. Also,
Speaker 2: this ologist has the best Scottish accent ever, So settle
Speaker 2: in get your blood humped to learn all about hematology
Speaker 2: with doctor Brian Derry. If you could tell me what
Speaker 2: is your specific title? Are you ed? Are you an oncologist.
Speaker 2: Are you my lowna specialists? What do you call yourself?
Speaker 4: Okay, so I'm a haematologist and I'm an oncologist. I'm both,
Speaker 4: so I'm qualified in both. And I'm an internal internist,
Speaker 4: an internal medicine specialist.
Speaker 2: So the site of blood does not freak you out.
Speaker 4: Well, strangely enough, the site of blood is. So when
Speaker 4: I got into hematology, you know, the specialty of blood diseases.
Speaker 4: I got interested because it was something that I could
Speaker 4: study under the microscope. So when you're learning and you're
Speaker 4: a scientist, and then you can make a slide and
Speaker 4: then you can look at it under the microscope. I
Speaker 4: was fascinated because I could see all these different blood
Speaker 4: cells and that was very exciting for me, where I
Speaker 4: could distinguish the different kinds. And so that's actually looking
Speaker 4: at the blood and researching the blood. That's how I
Speaker 4: became interested in the first place.
Speaker 2: Did you ever get a microscope when you were a kid?
Speaker 2: Is a gift or something? Or when did it start?
Speaker 4: This started when I went to medical school. So in
Speaker 4: medical school you're you're studying all kinds of things. But
Speaker 4: then when we started the part where we were using
Speaker 4: the microscope. That's where I got especially fascinated.
Speaker 2: Did you ever put your own blood under the microscope
Speaker 2: to see what was going on? Oh?
Speaker 4: Yes, you have to do that as a student.
Speaker 2: Really.
Speaker 4: Oh yes, you check your own blood and then you
Speaker 4: compare it with you know, all these other different things
Speaker 4: which you're given for comparison. You know.
Speaker 2: Wow, So did you ever eat a hamburger and then
Speaker 2: see what it looked like?
Speaker 3: And then?
Speaker 4: No? I didn't do that. Well, those things are not
Speaker 4: so obvious on your blood. Okay when you're just looking
Speaker 4: at it. Now, if you do chemical testing, obviously you
Speaker 4: could see something, but not just looking at it.
Speaker 2: And so when did you start studying oncology? Were you
Speaker 2: a heematologist first and then you started getting interested in
Speaker 2: blood diseases and cancers?
Speaker 4: Yes, basically that was it. So I did hematology training
Speaker 4: the Male Clinic in Rochester, Minnesota.
Speaker 2: Heard of it. Good place. Side note, I have some
Speaker 2: friends who have been treated at the Mayo Clinic and
Speaker 2: they said it was the best medical care they've ever gotten.
Speaker 2: Next level like Mayo Clinic is like those live flat
Speaker 2: first class cabin airline seats with the beds and the
Speaker 2: free wine and the salmon and the cheese. When you're
Speaker 2: used to a middle row seat and coach next to
Speaker 2: the toilet, sitting near someone with sausage purps, it's just
Speaker 2: so much better. Okay, Now back to the training of
Speaker 2: one of the world's leading cancer researchers who trained at
Speaker 2: the Mayo Clinic.
Speaker 4: So I started off with that, and then during my training,
Speaker 4: since I come from Scotland, so I was I'm an immigrant,
Speaker 4: I'm a foreign medical graduate, they actually assigned you a
Speaker 4: mentor or kind of like a coach. And so in
Speaker 4: that process, my mentor turned out to be a doctor
Speaker 4: called doctor Robert Kyle, who's actually very very famous in
Speaker 4: the field of multiple myeloma.
Speaker 2: Oh.
Speaker 4: And so by chance he turned out to be my
Speaker 4: mentor and we became good friends because we had both
Speaker 4: run boy Scout troops. Really he ran the boy Scoute
Speaker 4: Troup in Rochester, Minnesota, and I used to run the
Speaker 4: boy Scoute Troup in my hometown in Scotland.
Speaker 2: So you guys bonded and then started working together.
Speaker 4: Yes, and so his interest was myeloma in more into
Speaker 4: the blood cancer area HM and so I became more
Speaker 4: interested in that and then ended up doing both blood
Speaker 4: and cancer.
Speaker 2: So let's get right into it. What is blood? If
Speaker 2: you are walking around in an adult body, it contains
Speaker 2: roughly five liders of blood. That's a little over a gallon, slish,
Speaker 2: slashing around, so squishy. So what is it? What is blood? Well,
Speaker 2: stem cells in your bone marrow mature and they change
Speaker 2: into three types of blood cells, red blood cells, white
Speaker 2: blood cells, or platelets. So red blood cells care oxygen
Speaker 2: around the body, so you need that a bunch. And
Speaker 2: red blood cells also contain this protein. It's called hemoglobin,
Speaker 2: and it has iron and that combines with oxygen to
Speaker 2: give hemoglobin and our blood the awesome, terrifying red color
Speaker 2: that it has. Crabs, by the way, have blue blood,
Speaker 2: and earthworms and leeches have green blood. And there are
Speaker 2: some invertebrates like starfish that have clear blood. So unless
Speaker 2: you're one of those, or a plant or a robot,
Speaker 2: yours is red red blood cells. Let's be honest, life
Speaker 2: of the party party would be so dead without them. Now,
Speaker 2: white blood cells aka leukocytes, Those are cells of the
Speaker 2: immune system and they protect the body against infectious diseases
Speaker 2: and invaders. So they're like your friend who talks smacked
Speaker 2: to creeps when they hit on you and you're like, ugh,
Speaker 2: thank you, I didn't even see them. Finally, platelets are
Speaker 2: also called thrombocytes. It's cool name, and they're part of
Speaker 2: the blood. Their purpose is to stop bleeding. They do
Speaker 2: this by clumping and clotting. So when you're like, ugh,
Speaker 2: come on, let's leave, they're your friend who convinces you
Speaker 2: to stay at the party, and you're so so glad
Speaker 2: they did. If leaving a party was the same as
Speaker 2: bleeding out to death, which is not, but I needed
Speaker 2: an analogy. Okay, So these blood cells float in this
Speaker 2: salty straw colored liquid called blood plasma and blood plasma
Speaker 2: it's made of about ninety percent water and it also
Speaker 2: contains nutrients and electrolytes, gases, proteins, hormones, all kinds of stuff.
Speaker 2: So you are just this opaque ziplock full of a
Speaker 2: complex tomato soup, which is great, But what is blood cancer?
Speaker 2: It's not so great. When someone talks about cancer, it's
Speaker 2: usually preceded by a body part. So someone has throw cancer,
Speaker 2: liver cancer. You're like, okay, I'm not a surgeon, but
Speaker 2: I can picture the general area of this cancer because
Speaker 2: my brain is not made of turnups. But blood cancer
Speaker 2: is confusing because it's everywhere, there's nowhere, all at once.
Speaker 2: So you're about to get cocktail party literate on hematology.
Speaker 2: If you're ever introduced to a hematologist at a dinner
Speaker 2: party and you are able to impress them, I have
Speaker 2: done my job. Okay, here's a quick rundown of blood
Speaker 2: cancers that may confuse you if you see one of
Speaker 2: them listed on a flyer for a charity. So I'm
Speaker 2: gonna break it down so that you get the difference.
Speaker 2: Leukemia it's caused by this really rapid production of messed
Speaker 2: up white blood cells. They screw up the ability of
Speaker 2: the bone marrow to make red blood cells and platelets.
Speaker 2: That's leukemia white blood cells. Lymphoma is when these other
Speaker 2: white blood cells, called lymphocytes become abnormal. They turn into
Speaker 2: lymphoma cells. They multiply and they collect in your lymph notes.
Speaker 2: That messes up your immune system as well. Now, my
Speaker 2: loma is cancer of the plasma cells. So doctor dry
Speaker 2: sums it up.
Speaker 4: And so the borne marrow is where you make your blood, Okay,
Speaker 4: And so when you have a cancer of the blood,
Speaker 4: actually it's a cancer of the borne marrow because what
Speaker 4: has happened is that the borne marrow has been damaged
Speaker 4: by something and so then it's not making blood like
Speaker 4: it should and maybe even has turned into a cancer
Speaker 4: of the born marrow. Okay, Now, in the case of leukemia,
Speaker 4: that means that you stop making the normal blood cells
Speaker 4: and make the leukemia cells. In the case of myeloma,
Speaker 4: it means that you have a problem with the plasma cells,
Speaker 4: which is a particular kind of a cell in the
Speaker 4: borne merew which is the cell which is part of
Speaker 4: your immune system. So it's actually a cancer of the
Speaker 4: immune system. And in your born marrow you make the
Speaker 4: antibodies to fight infection.
Speaker 2: Why would your bone marrow Do you like that what
Speaker 2: happened and what happens to make the bone marrow turn
Speaker 2: in blood cancers or what happens in general with cancer
Speaker 2: to suddenly us.
Speaker 4: So what causes it? Yeah, Well, I think that there's
Speaker 4: been a lot of controversy over the years, specifically about myeloma,
Speaker 4: because it seems like more than one kind of toxic
Speaker 4: exposure can cause myeloma. Really, so for lung cancer, there's
Speaker 4: a strong connection to cigarette smoking and the carcinogens, the
Speaker 4: cancer causing chemicals which are in cigarette smoke. Okay, so
Speaker 4: for myeloma, there's been a connection with many different kinds
Speaker 4: of chemicals and so as long as like one hundred
Speaker 4: years ago, it was noticed that people who work with benzene,
Speaker 4: which is a solvent in paints and in factories where
Speaker 4: they do all kinds of manufacturing with solvents and glues,
Speaker 4: people who worked with benzene would get myeloma. Really yeah,
Speaker 4: so there is a linkage which is called like a
Speaker 4: proof of principle, where if you're exposed to a cancer
Speaker 4: causing chemical in this case, it can sometimes cause myeloma.
Speaker 2: Let's lay down a few more basics. So first off, yes,
Speaker 2: cancer was named after a crab because of the way
Speaker 2: veins branched off from a tumor, which sounds gross and
Speaker 2: very moist. Also, cancer doesn't have to be a tumor
Speaker 2: or a lump that you can like poke with a stick.
Speaker 2: Cancer just means when abnormal cells divide in an uncontrolled way,
Speaker 2: so some cells get a little wonky and then they
Speaker 2: just keep making more wonky cells. So according to the
Speaker 2: American Cancer Society, it's caused like changes in the cells DNA,
Speaker 2: So that's the genetic blueprint, and some of these changes
Speaker 2: can be inherited. Others can be caused by environmental factors,
Speaker 2: such as, for example, these things. Ready, I'm gonna list
Speaker 2: these off. There's a long list, but I'm gonna reduce
Speaker 2: some that I can pronounce alcoholic beverages, benzines, tanning beds, sawdust,
Speaker 2: a bunch of chemical compounds. I can't pronounce the virus
Speaker 2: that causes mono diesel exhaust, estrogen therapy, processed meat, aluminum production, tobacco, asbestos,
Speaker 2: and quote salted fish Chinese style. I saw that last
Speaker 2: one and was like, damn, that is specific, So what
Speaker 2: is up with salted fish comma Chinese style? Well, turns
Speaker 2: out Cantonese salted fish is a dish common in Southern China,
Speaker 2: where fish are gutted and they're hung in a heap
Speaker 2: of salt to preserve it. Apparently, studies since the nineteen
Speaker 2: sixties have shown that the Southern Chinese fishing populations who
Speaker 2: consume it as a staple are at a higher risk
Speaker 2: for cancer. This also led me down a hole of
Speaker 2: Chinese slang surrounding salted fish, and in Cantonese, dead bodies
Speaker 2: are referred to as salted fish, and a salted fish
Speaker 2: coming back to life means a person is making a
Speaker 2: comeback after their career looks belly up. And the phrase
Speaker 2: those who eat salted fish must put up with thirst
Speaker 2: is essentially check thyself before thou dost wreck thineself. So
Speaker 2: there are a lot of things already identified as things
Speaker 2: I'll mess up your DNA, but there are so many
Speaker 2: environmental factors that we have no idea about yet. Do
Speaker 2: you think that there's a ton of substances that we
Speaker 2: are in exposure to that we'll find out later we
Speaker 2: really shouldn't have been exposing ourselves to.
Speaker 4: This is so absolutely true. Is one of the very
Speaker 4: very big concerns that I have. And so since the
Speaker 4: industrial and chemical revolution, since the Second World War, over
Speaker 4: one hundred thousand chemicals have been introduced into the environment
Speaker 4: that we are exposed to one hundred thousand, and all
Speaker 4: of those only a handful have been carefully studied and
Speaker 4: have proper regulations with regard to use and cautions and
Speaker 4: things like that.
Speaker 2: Okay, one second, I'm just going to bury my face
Speaker 2: in my arm and grown for like an hour.
Speaker 4: And so I really do have a deep concern that
Speaker 4: we will discover many many cancer causing chemicals have been
Speaker 4: out there and we've not been paying it tension. Now
Speaker 4: we've learned a little bit about this. So for example,
Speaker 4: with the nine to eleven event in New York, all
Speaker 4: these chemicals were released with the fire, with the combustion,
Speaker 4: and then there was a big development of myeloma in
Speaker 4: people after the nine to eleven event because they were
Speaker 4: exposed to fire retardants and solvents and all kinds of
Speaker 4: different chemicals that were suddenly at high levels and really
Speaker 4: causing a problem.
Speaker 5: Wow.
Speaker 2: So we're still having to look at cases and try
Speaker 2: to find correlations between exposure.
Speaker 4: That is correct. So we're at this point of checking correlating.
Speaker 2: And as a scientist, do you like getting the data
Speaker 2: and trying to crunch the data or are you more
Speaker 2: interested in kind of the care aspects of being a doctor?
Speaker 2: How do you approach getting all that data? Quick question
Speaker 2: anologyites do you say data or this messes with me
Speaker 2: every time I say it, and so I usually just
Speaker 2: say it both ways in a conversation. That way, I
Speaker 2: am guaranteed to be wrong every time I looked into it.
Speaker 2: And it seems to be a matter of regional dialect.
Speaker 2: Although I landed on this webpage of a woman named
Speaker 2: Susan Ryan. She's an American dialect coach who insists that
Speaker 2: it's data, and for some reason I found her helpful
Speaker 2: recording very soothing. And then I went down some holes
Speaker 2: and listened to her say a bunch of other.
Speaker 5: Words data, data, database, database, data, database.
Speaker 2: And Susan, according to her bio, is also quote a
Speaker 2: former Alcatraz Park ranger, avid birdwatcher, and a Lingui file
Speaker 2: who makes a mean scrambled egg a la Julia child.
Speaker 2: I would roll in her posse for sure if she
Speaker 2: wanted to be friends. Okay, so does doctor Derry prefer
Speaker 2: crunching the data or being bedside right?
Speaker 4: So over the years I've done both types of things,
Speaker 4: which I would say is quite challenging and became increasingly
Speaker 4: challenging over the years. And so I've always seen patients
Speaker 4: in the clinic. You know, I had a myeloma clinic,
Speaker 4: so one or two days a week I would always
Speaker 4: just see myeloma patients. But in addition to that, for
Speaker 4: most of my life I ran a lab where I
Speaker 4: was studying myeloma and crunching numbers from cell cultures from
Speaker 4: statistics and all kinds of things like that. So I've
Speaker 4: done both kinds of things mostly my whole career.
Speaker 2: Oh wow, so you've gotten both of them. Yes, and
Speaker 2: then what are you working on now? Tell me, like
Speaker 2: a little bit about gene editing or crisper. How does
Speaker 2: that factor into your work? Crisper, by the way, is
Speaker 2: spelled with no E, and at first glance, it looks
Speaker 2: like an app that disrupts them let us in straight.
Speaker 2: But CRISPER is a DNA sequence that stands for clustered
Speaker 2: regularly interest based short palindromic repeats. You're fine, you don't
Speaker 2: have to memorize that. And CRISPER technology lets geneticists edit
Speaker 2: parts of the genome. It's crazy and exciting. And doctor
Speaker 2: Derry I feel weird calling him just Brian, so I
Speaker 2: just keep calling him doctor Derry. I don't know anyway,
Speaker 2: Doctor Derry is working on a bunch of things for
Speaker 2: something called the Black Swan Research Initiative. The name has
Speaker 2: a cool, weird origin. It kind of surprised me. Why
Speaker 2: is it called black Swan?
Speaker 4: Because you are you're looking for something that is it's
Speaker 4: hard to find and you may not recognize it. Right away.
Speaker 4: In the western world, everybody thought swans were white, and
Speaker 4: so you have this idea swans are white. But then
Speaker 4: the first ships went to Australia and over by Perth
Speaker 4: on the West coast and they sailed up the Swanee
Speaker 4: River and lo and behold the swans were black. So
Speaker 4: they realize that you have to open up your mind
Speaker 4: and look at things a little differently and say, okay,
Speaker 4: there are swans. Usually they're white, but actually in Australia
Speaker 4: they're black, and in other parts of the world they're
Speaker 4: brown and maybe slightly different different colors. And so it's
Speaker 4: a project where you have to open your mind and
Speaker 4: be open to different strategies to solve your problem.
Speaker 2: Are you seeing a lot of scientists and oncologists finding
Speaker 2: the genes that could make one more susceptible to cancer?
Speaker 2: Are those getting identified?
Speaker 4: Absolutely? This is a very very active area of research,
Speaker 4: and so through the Black Swan Project, we have a
Speaker 4: couple of groups doing just this, so that in Germany
Speaker 4: we have a group looking at family myeloma, So they
Speaker 4: are looking at families where there are two or more
Speaker 4: in individuals within the family that developed myeloma, and we're
Speaker 4: collecting a whole series of these families to figure out, well,
Speaker 4: what is it that's that's causing this susceptibility, And we're
Speaker 4: studying them at the genetic level. And what I can
Speaker 4: tell you already is that there are several types of
Speaker 4: genetic predispositions.
Speaker 2: So side note, my uncle Joe also had multiple maloma.
Speaker 2: He did not make it, which is another reason why
Speaker 2: I'd love to interview ologists like doctor Derry. It's so
Speaker 2: crazy to me that people are doing this and just
Speaker 2: walking among us, like buying a phone case at Target.
Speaker 2: You might never know that this person behind you in
Speaker 2: line is working on something you could save your life
Speaker 2: or a family member's life. It's it's nuts. So how
Speaker 2: long before you can see things like gene editing like
Speaker 2: chrispur being used in the treatment of oncology? How long?
Speaker 2: How far away is that.
Speaker 4: It's happening now? Oh, it's happening now. How So what
Speaker 4: you can do is you can edit the immune cells.
Speaker 4: So you may have heard about a very active type
Speaker 4: of therapy called immune therapy, and one type is called
Speaker 4: car T cells. And this is a situation where you
Speaker 4: take the immune cells, the T cells from the patient
Speaker 4: and then you engineer them and then you give them back.
Speaker 2: So car T stands for chimeric antigen receptor T cell
Speaker 2: therapy car T, So if you hear this, the essential
Speaker 2: deal is that car T cell therapy is a way
Speaker 2: to get immune cells called T cells, which is a
Speaker 2: type of white blood cell, to fight cancer by changing
Speaker 2: them in a lab so that they can find and
Speaker 2: destroy cancer cells. Pretty awesome.
Speaker 4: With the gene editing approach, you can really edit and
Speaker 4: tweak those T cells to really recognize an attack in
Speaker 4: a very specific way the cancer that you're interested in.
Speaker 4: In China, they are already doing this. They have a
Speaker 4: trial where they're treating lung cancer using these edited T cells,
Speaker 4: and we're starting to look at doing it in myloma.
Speaker 4: It's like science fiction that we're moving so quickly.
Speaker 2: When you're doing your research, are you splitting your time
Speaker 2: between chemical therapies and also these genetic therapies that can
Speaker 2: kind of prevent or treat it.
Speaker 4: Yes. So the way that this kind of slots into
Speaker 4: the day to day activity is that most patients when
Speaker 4: they start out, we have these therapies that we know
Speaker 4: can work well, but then we know that those will
Speaker 4: produce remissions for a few years. But then when that
Speaker 4: impact is starting to wear off, then they need new therapies.
Speaker 4: And so this is the perfect situation and opportunity to say, Okay,
Speaker 4: what are the new therapies that can rescue and treat
Speaker 4: at this point? And then from those like the car
Speaker 4: te cells look very promising and so we're thinking, my god,
Speaker 4: they are really rescuing pretty well in the relapse situation.
Speaker 4: Maybe we should be using them even earlier.
Speaker 2: And so are we five or ten years off from
Speaker 2: this happening in the US do you think?
Speaker 4: Or no, it's happening. This is a very rapidly changing field.
Speaker 4: So car te cells have been approved, not using the
Speaker 4: crisper but just in general. They've been approved for leukemia
Speaker 4: and lymphoma in the US. And so this has been
Speaker 4: described as like a new space race Sputnik two, where
Speaker 4: the Chinese are working on it and the US are
Speaker 4: working on it. It's really like competitive.
Speaker 2: Are your friends or is it a little bit like,
Speaker 2: oh what are you working on? Is it like watching
Speaker 2: cooks on a cooking competition.
Speaker 4: There is quite a bit of that. They're all cooking
Speaker 4: up their own brew, you know, and you know, there's
Speaker 4: a little bit of competition and that what you're cooking
Speaker 4: could be the best you know and it's it's good.
Speaker 2: I welcome this competition. I'm like, whatever it gets you
Speaker 2: guys working fastest, I'm into it right.
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Speaker 2: My dad has had some questions he wanted me to
Speaker 2: ask you. He is as a patient and also as
Speaker 2: a former journalist who loves to research. Thanks, He's on it.
Speaker 2: He's on all the blogs he wanted to know. He
Speaker 2: wants to know why cancer drugs are so expensive, how
Speaker 2: much of the cost is research related, and how much
Speaker 2: is related to protection against lawsuits. Okay, once again the
Speaker 2: listener questions, they're all from a dad this week, because
Speaker 2: this is a spec ep of ologies and this question
Speaker 2: is about the cost of pharmaceuticals. His chemo therapy comes
Speaker 2: in a pill form he takes every day at four pm,
Speaker 2: and it's called Revlimid. It's saving his life and it's
Speaker 2: thankfully covered by a program called Veterans' Choice, but the
Speaker 2: retail price if it weren't covered, would be over sixteen
Speaker 2: thousand dollars per month. Why does it cost so much?
Speaker 4: Right, so, this is really a lot of reasons why.
Speaker 4: The main reason that's poot forward, why certainly on behalf
Speaker 4: of the form of companies, is that they have development
Speaker 4: cost you know, they're testing this drug, testing that drug,
Speaker 4: and then they've got to do all these trials which
Speaker 4: are very expensive, cost millions of dollars to test and
Speaker 4: make sure it's safe and things like that.
Speaker 2: This drug did cost several million dollars to research and develop,
Speaker 2: but it's made twenty billion dollars for its parent company
Speaker 2: since it's released in two thousand and four, and the
Speaker 2: price keeps going up. Now, on the other side, it's
Speaker 2: hard not to be grateful that people are even working
Speaker 2: on this. Also, the makers are being sued class action
Speaker 2: lawsuit because they failed to share some information that would
Speaker 2: help get a cheaper generic out there. Come on, guys.
Speaker 4: But then ultimately there is this question that for example,
Speaker 4: Revlomid has been on the market for quite a number
Speaker 4: of years now, and so you would say, well, you know,
Speaker 4: absolutely there were development costs, but you know this is
Speaker 4: ten years later, you know, fifteen years later, so maybe
Speaker 4: this would be the time to have a more reasonable cost, right,
Speaker 4: And so this is something that is really prominent at
Speaker 4: the political level right now. I mean, what are reasonable
Speaker 4: drug costs? And so that has become a complicated process
Speaker 4: where the companies they extend their patents and then even
Speaker 4: the generic folks when they come in, they don't reduce
Speaker 4: across so much, you know, so everybody's in it to
Speaker 4: make a buck. And so this is in my opinion,
Speaker 4: very tragic and difficult because this is not like selling
Speaker 4: cars or watches, you know, where you say, well, this
Speaker 4: is a beautiful watch. You could have a markup, that's fine,
Speaker 4: But this is drugs that are to save people's lives,
Speaker 4: and so I'm not so happy about markups in that environment.
Speaker 2: If you want to know why watches can be so expensive.
Speaker 2: By the way, and you deeply enjoy some j Z
Speaker 2: watch puns, listen to the horology episode of Ologies Just
Speaker 2: get It, Just say it. What you could buy for
Speaker 2: sixteen thousand dollars a month instead of twenty eight pills
Speaker 2: or thirty pills.
Speaker 4: Right, Oh my gosh, I know. And so you see,
Speaker 4: in other areas it's been easier to work around it. So,
Speaker 4: for example, in the area of surgery. So people say, well,
Speaker 4: you know, I could get my need replaced in Nevada,
Speaker 4: or maybe I could fly to Thailand and get it
Speaker 4: replaced and it would be half the price, even including
Speaker 4: the cost of the flight.
Speaker 2: You know, it's so crazy. I know, I you know,
Speaker 2: we joke that my dad, my dad's five hundred dollars
Speaker 2: pills are like Kim Kardashian level. If you spent that
Speaker 2: amount of money on like champagne and Yah, you'd be
Speaker 2: rolling exactly. So instead of taking that one five hundred
Speaker 2: dollars pill a day that's saving his life, my dad
Speaker 2: could be every day getting bottle service, which starts at
Speaker 2: around four hundred dollars at LA's douche As nightclubs. Or
Speaker 2: he could be buying every day one pair of Easy
Speaker 2: Clear PBC stiletto pumps. Dad. A PBC pump isn't a
Speaker 2: plumbing thing. It's like a clear plastic high heel designed
Speaker 2: by Kanye West.
Speaker 4: And so I think I do see that this has
Speaker 4: to be addressed. It is unsustainable.
Speaker 2: So do oncologists collab, do they work together? Do they
Speaker 2: play nice?
Speaker 4: I would have to say though that outside of the US,
Speaker 4: we've been really, really excited and had the opportunity to
Speaker 4: work with some great teams, you know, outside of the US,
Speaker 4: who are doing amazing things. One of the coolest projects
Speaker 4: that we're doing is in Iceland. What so we're studying
Speaker 4: everybody in Iceland?
Speaker 2: Everyone?
Speaker 4: Everyone?
Speaker 2: How many people are in Iceland?
Speaker 4: Three hundred and forty thousand? That's it?
Speaker 2: Yes, Oh gosh, that's like that's like studio city in
Speaker 2: La That's like Los Felas or something. Right, Okay, I
Speaker 2: was way off. The population of the La suburbs Studio
Speaker 2: City is thirty seven thousand, Los Felas just about the same,
Speaker 2: So I was wrong. But three hundred and forty thousand
Speaker 2: is less than the population of Staten Island, And it's
Speaker 2: about equal to the total attendance of one Coachella weekend,
Speaker 2: which is a very bone chilling statistic. Coachella is so crowded,
Speaker 2: you guys.
Speaker 4: But it's a whole country, and so there are so
Speaker 4: many opportunities where you could test and then offer therapies
Speaker 4: to a whole country where you're not excluding anyone. So
Speaker 4: they're all part of the same electronic medical record system. Wow,
Speaker 4: so you know what's happening to everyone from the time
Speaker 4: they're born all the way through until they're getting diseases
Speaker 4: and having issues. So the other thing that happened is
Speaker 4: that there's a big genetic company in Iceland called Decode
Speaker 4: Genetics that actually did DNA sequencing of.
Speaker 2: All the people everyone.
Speaker 4: Yes, wow, mind boggling cost. In real money, it would
Speaker 4: have cost billions of dollars, but they did it in
Speaker 4: a different way where it didn't cost them quite so much.
Speaker 4: And so this is incredibly powerful, incredibly powerful, and so
Speaker 4: we will learn what are called the driving mutations, the
Speaker 4: ones that are leading us forward. And this will be
Speaker 4: a huge opportunity for Crisper. So once we say, oh
Speaker 4: my god, this is the gene, well, we would be
Speaker 4: able to edit it wow, and prevent and to treat.
Speaker 4: So it's going to lead in to all these new
Speaker 4: molecular opportunities.
Speaker 2: Thanks Iceland. I asked if eating walnuts helps, because we
Speaker 2: read that eating walnuts helps, and you guys, my dadd
Speaker 2: eats walnuts every day. Maybe walnuts are magic. Maybe walnuts
Speaker 2: are the brains of aliens from another dimension and they
Speaker 2: fix everything. Maybe they just have a lot of antioxidants.
Speaker 4: But you do need to have your body and your
Speaker 4: immune system in the best shape to accept all these
Speaker 4: kinds of therapies. Right, And it's clear that having your
Speaker 4: best diet, your best vitamin combination is absolutely helpful, but
Speaker 4: you shouldn't have too high of an.
Speaker 2: Expectation walnuts are not a reliable cure. But duh. But
Speaker 2: this next part rules totally blew my mind.
Speaker 4: And so I've been most interested to study places where
Speaker 4: people live to be over one hundred, where they're apparently
Speaker 4: pretty healthy, and the question is what are they eating?
Speaker 2: Yeah, exactly, probably not as much jack in the box
Speaker 2: as we do.
Speaker 4: But that is the summary. That is the exact summary.
Speaker 4: So the first place, they're called blue zones, and the
Speaker 4: first one is a Greek island close to Turkey called Ikaria,
Speaker 4: And so they have a Mediterranean diet as you might expect, right,
Speaker 4: and so they have also very low stress. They have
Speaker 4: no clocks on the island, so they're not concerned about time.
Speaker 2: Are you kidding me?
Speaker 4: So they have low stress, they have no clocks, no mortgage. See,
Speaker 4: these are families that have lived there for hundreds of years,
Speaker 4: and so they're just living there and they have you know, chickens,
Speaker 4: they can go fish in the ocean, and they some
Speaker 4: grow some grapes, have some nice red wine, and they
Speaker 4: have a Mediterranean diet, and so this combination seems to
Speaker 4: be rather healthy. But there is no jack in the box, right,
Speaker 4: you know. And they don't they don't eat junk food,
Speaker 4: they don't eat diet, they don't have diet drinks. You know,
Speaker 4: they do drink wine, they do drink teas, they put
Speaker 4: honey in as a sweetener, so they do a lot
Speaker 4: of like healthy things, and so it is possible to
Speaker 4: come up with like a healthy diet.
Speaker 2: So all you have to do is move to an
Speaker 2: island utopia and you're fine now if you're not into
Speaker 2: Greek isles. Some of the other Blue zones are Okinawa,
Speaker 2: Japan Island, Sardinia, Italy island, Nicoya in Costa Rica, which
Speaker 2: is a peninsula. I'm blowing your mind right now, but
Speaker 2: peninsula comes from pennae in Sula, which means almost an island,
Speaker 2: case in point. And finally, okay, what's the last island?
Speaker 2: You think it's going to be? Lo Molnda, California, which
Speaker 2: is not an island. It's this weird outskirt suburb of
Speaker 2: Los Angeles. There's a group of Seventh Day adventists that
Speaker 2: live a life so chill that this one little area
Speaker 2: counts as a blue zone. Very shocking. So some commonalities
Speaker 2: that lead to these long, relatively disease free lives are
Speaker 2: family putting it ahead of other concerns, less smoking, semi vegetarianism,
Speaker 2: the majority of food consumed derived from plants, moderate physical activity,
Speaker 2: social engagement, and finally, beans commonly consumed are legomes. So
Speaker 2: it's part diet, part behavior.
Speaker 4: And also a healthy pattern of behavior, which is to
Speaker 4: we can't ignore the time, but we can certainly try
Speaker 4: to reduce that time stress factor.
Speaker 2: Right, I am doing everything the opposite of everything you
Speaker 2: just described, and also scare me out of diet drinks?
Speaker 2: Should I? We shouldn't be drinking diet drinks, right you
Speaker 2: should not?
Speaker 6: Okay?
Speaker 2: Good to know? How do they kill us?
Speaker 4: And things like coke they do have that brown color
Speaker 4: of the colke. That caramel is not so healthy in fact,
Speaker 4: so the dyes are not so healthy. And then the
Speaker 4: things like asparteam that the sweeteners those are not good either.
Speaker 2: So I just started down a rabbit hole about diet
Speaker 2: sodas and the links to various diseases and increased weight gain.
Speaker 2: And a higher incidence of depression, and man, go research
Speaker 2: it if you want to be scared off. I have
Speaker 2: to do another episode just all about that. It reminds
Speaker 2: me of the days when our parents generation smoked like
Speaker 2: indoors and on airplanes and in like neonatal ICUs and
Speaker 2: in offices, and they were like, yeah, everyone knew was bad,
Speaker 2: but you know, this is what people did, and now
Speaker 2: we find it horrifying.
Speaker 4: There's a number of different things about those drinks that
Speaker 4: can be negative. So juices, water, wine, teas, those are
Speaker 4: all good, but diet drinks no.
Speaker 2: Okay. Good to know that cements my position on that
Speaker 2: I may have had one yesterday kilously, I've been like,
Speaker 2: what am I doing to myself? So what are in
Speaker 2: terms of other or actually this is a personal question,
Speaker 2: but being a doctor and a hematologist noncologist, how often
Speaker 2: do you notice symptoms in yourself like back pain or
Speaker 2: does my shoulder herd? Or do I have this? Or
Speaker 2: are you pretty much not a hypochondriac because you know
Speaker 2: so much about medicine, Because I feel like the rest
Speaker 2: of the population walks around every day being like do
Speaker 2: I have cancer? As an oncologist, do you do you
Speaker 2: think about that.
Speaker 4: Yeah, I do. I think that I'm not a hypochondriac,
Speaker 4: and I think it does help to understand that, you know,
Speaker 4: we all like might tweak her back one day, you
Speaker 4: get up the wrong way, or you you know your
Speaker 4: on or you walk the wrong way, but it's not cancer,
Speaker 4: you know, and you know it'll be gone in a
Speaker 4: few days, so you don't need to rush to get
Speaker 4: scans and blood tests and things that you'll be you'll
Speaker 4: get over it. And so I think there's a tendency
Speaker 4: to think that, you know, if you come down with
Speaker 4: a really bad cold or something, that it's going to
Speaker 4: be the start of something really bad. Right now, we
Speaker 4: don't want to ignore those things, of course, but certainly
Speaker 4: individually maybe less immediately worried.
Speaker 2: Right so you at least know what to look for. Yes, okay,
Speaker 2: that's good. So okay. Doctors aren't usually paranoid hyperchondriacs. I
Speaker 2: will say there is a hugely studied reluctance, particularly in men,
Speaker 2: to go to the doctor when they feel a little off.
Speaker 2: Men also have shorter life expectancy. So if you're feeling
Speaker 2: off and you can't catch your breath, your bones hurt,
Speaker 2: your vision gets weird, whatever your symptoms for whatever, go
Speaker 2: to a doctor. My dad ignored feeling awful for months
Speaker 2: and my mom finally forced him to go and by
Speaker 2: that point they just legit admitted him to the hospital
Speaker 2: for blood transfusions. She saved his life. Way to go, Nancy,
Speaker 2: So dudes, go to doctors. Dad, go to the doctor.
Speaker 2: Next time Mom tells you too, do you have to do?
Speaker 2: You have a lot of people in your family that
Speaker 2: are call you a text you and say doctor durry.
Speaker 4: Well, yes, quite a few, although I would say that
Speaker 4: within my family and friends that are not so hypochondriac.
Speaker 2: That's good. Maybe it's a Scottish thing.
Speaker 4: It's a Scottish thing. Yes, yes, so so my mother
Speaker 4: lived to be close to one hundred and my sister's
Speaker 4: pretty old, you know, so we were not like we're fortunate.
Speaker 4: We're not an unhealthy group of people.
Speaker 2: Good. You've probably stayed away from diet coke and hamburgers. Now,
Speaker 2: last couple questions, last two questions. What is something that
Speaker 2: is the part of your job, part of your work
Speaker 2: that is the most challenging. That is maybe the thing
Speaker 2: that's more of a slog or something that is difficult.
Speaker 2: And then I'll ask you what your favorite thing is.
Speaker 2: What is something anything from parking to h Yeah.
Speaker 4: Well, I think that the saddest and the most difficult
Speaker 4: thing has been the way that medicine has changed over
Speaker 4: the years that I've been practicing. Medicine is where, you know, I,
Speaker 4: for many years practice practiced it on an individual basis,
Speaker 4: where I would have my patients, you know, and I
Speaker 4: would take care of them. If they went to the hospital,
Speaker 4: I would see them, and then when they came out,
Speaker 4: I would take care of them. But now medicine's become
Speaker 4: a business. You know, I take care of them, you know,
Speaker 4: I'm not there on the Saturday. Somebody else takes care
Speaker 4: of them. They end up in the hospital, and then
Speaker 4: this happens, and that happens, and then it's a whole
Speaker 4: bureaucratic nightmare where the individual individuality of the patient care
Speaker 4: has really lost that personal possibility. The paperwork is enormous,
Speaker 4: and then there are so many challenges when you see
Speaker 4: your patient. And I would say that the biggest one
Speaker 4: is something that we touched on already, is you know,
Speaker 4: I want to give this cocktail, this medicine, will my
Speaker 4: patient be able to get it and to afford it,
Speaker 4: and this is just so difficult, and as I travel
Speaker 4: around the world. Obviously there are issues here in the US,
Speaker 4: but outside of the US.
Speaker 2: So once again, as much as the price of some
Speaker 2: therapies are infuriating, we are lucky to have them.
Speaker 4: I mean, there are whole countries that don't have revelement.
Speaker 4: I mean, so that means that they don't have access
Speaker 4: to anything beyond therapies that we had in the year
Speaker 4: two thousand and So this is a really a sad
Speaker 4: and difficult thing for me to see that there are
Speaker 4: so many patients that don't have the treatment that they
Speaker 4: deserve and that they need.
Speaker 2: I imagine also the work that you do. You have
Speaker 2: such an interest in seeing how each of these patients does.
Speaker 2: Getting to follow through is probably it's probably pretty gratifying,
Speaker 2: right right.
Speaker 4: So now you know I have patients that I see
Speaker 4: twenty years later.
Speaker 2: Ah, that's great. Tried really hard not to cry at
Speaker 2: this point of the interview.
Speaker 4: Which is fantastic, you know, and you know, they'll remind
Speaker 4: me that when I first met them, I said that
Speaker 4: my expectation was three or four years.
Speaker 2: Wow.
Speaker 4: And then you know I had a patient recently. She
Speaker 4: and her husband they reminded me that I'd said that,
Speaker 4: but it was it's twenty years now.
Speaker 2: That's great. I love it when doctors are wrong in
Speaker 2: that fashion. That must be the best.
Speaker 4: That's the best, okay.
Speaker 2: And so what is your favorite thing about hematology or
Speaker 2: blood or what you do, Like, what is the thing
Speaker 2: that just really kind of gets you excited about starting
Speaker 2: your week?
Speaker 4: Well, I think the most exciting thing is that we
Speaker 4: are starting to make so much progress, that we have
Speaker 4: these new drugs, that patients are living longer, and so
Speaker 4: that when I see a new patient now it's kind
Speaker 4: of not like, oh my god, you know it's going
Speaker 4: to be two, three, four years. You know, Oh, I
Speaker 4: can say, well, we're expecting you to live at least
Speaker 4: seven to ten years, and during those seven to ten years,
Speaker 4: we'll probably have something even better.
Speaker 2: That's great.
Speaker 4: You know. So it's really more of a joy. It's
Speaker 4: still a lot of hard work, but it's a much
Speaker 4: more positive situation than it was before.
Speaker 2: Try not to cry while editing this, but still crying
Speaker 2: a little bit. That's great. That's got to be. That
Speaker 2: has to give you so much motivation for doing your
Speaker 2: best on the job.
Speaker 4: Exactly exactly, Well.
Speaker 2: This has been so this has been so informative. Thank
Speaker 2: you so much for sitting down with me. I can't
Speaker 2: believe it all started with blood under a microscope.
Speaker 4: Right, well, thank you for your very insightful questions, which
Speaker 4: very very good to have a chance to talk to
Speaker 4: you about these things.
Speaker 2: Of course, some of them come directly from Larry Ward
Speaker 2: in the matter.
Speaker 4: Right, Let's tell Larry Ward that I am very happy
Speaker 4: to give these answers and many more as the questions
Speaker 4: pop in his head.
Speaker 2: Okay, oh good, Thank you so much.
Speaker 4: Doctor.
Speaker 2: This is great. Sum Let's all move to tiny islands
Speaker 2: and live to be one hundred or at least stop
Speaker 2: eating garbage and go to the doctor when we're sick.
Speaker 2: So I want to say a huge thanks to the
Speaker 2: Peter Boyle family and Lorraine Boil for their work in
Speaker 2: raising millions of dollars to find a cure for multiple maloma,
Speaker 2: and to Peter Anton and Randy Lovett and everyone at
Speaker 2: the International Maloma Foundation for access to doctor Durry. Thank
Speaker 2: you to him. More info is at myeloma dot org.
Speaker 2: Also side note, my mom has MS, so if there's
Speaker 2: a neurologist out there, holler at my face. Thanks to
Speaker 2: Stephen Ray Morris for editing this down to the wire
Speaker 2: because I'm so behind after getting stuck in the Northeast
Speaker 2: bomb cyclone storm this past week, I'm so behind. He's
Speaker 2: editing this like hours before it goes up. Thank you, Steven.
Speaker 2: I owe you a million dinners. Thanks to Hannah and
Speaker 2: Aaron for running the Ologies Facebook group, which you can
Speaker 2: totally join. Thank you for being great friends. Also, all
Speaker 2: kinds of Ologies merch is available at ologiesmerch dot com.
Speaker 2: There's t shirts and hats and pins, and the sales
Speaker 2: help make this podcast possible, So thank you Shannon Feltus
Speaker 2: and Bonnie Dutch for that. They do awesome design work
Speaker 2: and I heart them. If you like the podcast and
Speaker 2: you want to support it, you can become a patron
Speaker 2: for as little as twenty five cents an episode at
Speaker 2: patreon dot com slash Ologies. You may notice I do
Speaker 2: this ad free, so this helps me pay the cost
Speaker 2: of production. You can also help so much for zero
Speaker 2: dollars just by signal boosting. You can rate and review
Speaker 2: on iTunes. That helps so much. So does instagramming, tweeting
Speaker 2: about the podcast, telling a friend Ologies is at Ologies
Speaker 2: on Twitter and Instagram. I'm Ali ward on both and
Speaker 2: for your end of the episode. Secret. Okay, oh no, okay. Once,
Speaker 2: I didn't want to pick up a phone when somebody
Speaker 2: called me, so I didn't answer. But while it was ringing,
Speaker 2: I fully clothed, got in the shower, walked into my
Speaker 2: shower without the water on, stood there for just a
Speaker 2: few seconds while the phone rang, and then I stepped
Speaker 2: out so that I could technically say later, I'm so
Speaker 2: sorry I was in the shower when you called and
Speaker 2: not be lying, which is insane. It would be better
Speaker 2: just to lie or say that I didn't feel like
Speaker 2: talking to you, but lying seem so evil, So I
Speaker 2: don't know. I don't know. I'm working it out. So
Speaker 2: now that's your end of the show. Secret. Okay, that's
Speaker 2: it for this week. Thank you so much for listening.
Speaker 2: I like you so much. Very honestly, go ask smart
Speaker 2: people dumb questions, because curiosity is never not cool. Okay,
Speaker 2: bye bye. Pacodermatology, hobbiology or do zoology, lithology and technology, meteorology, paratology, ethology, zeriology, elinology.
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Speaker 7: every Day Employers.
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