Classical hematology research with Dr. Scott Peslak

1 00:00:00,000 --> 00:00:05,860 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills 2 00:00:05,860 --> 00:00:11,260 to build their own research program, whether or not they have a mentor. 3 00:00:11,260 --> 00:00:17,340 As clinicians, we spend a decade or more as trainees learning to take care of patients. 4 00:00:17,340 --> 00:00:22,380 When we finally start our careers, we want to build research programs, but then we find 5 00:00:22,380 --> 00:00:27,780 that our years of clinical training did not adequately prepare us to lead our research 6 00:00:27,780 --> 00:00:29,180 program. 7 00:00:29,180 --> 00:00:35,480 Through no fault of our own, we struggle to find mentors, and when we can't, we quit. 8 00:00:35,480 --> 00:00:40,580 However, clinicians hold the keys to the greatest research breakthroughs. 9 00:00:40,580 --> 00:00:46,200 For this reason, the Clinician Researcher podcast exists to give academic clinicians 10 00:00:46,200 --> 00:00:51,800 the tools to build their own research program, whether or not they have a mentor. 11 00:00:51,800 --> 00:01:01,060 Now introducing your host, Toyosi Onwuemene. 12 00:01:01,060 --> 00:01:03,260 Welcome to the Clinician Researcher podcast. 13 00:01:03,260 --> 00:01:07,580 I'm your host, Toyosi Onwuemene, and it is such a pleasure to be here today because I'm not 14 00:01:07,580 --> 00:01:08,580 by myself. 15 00:01:08,580 --> 00:01:13,460 Today, I have an extra special guest, Dr. Scott Peslak, and I'm going to ask him to 16 00:01:13,460 --> 00:01:14,460 introduce himself. 17 00:01:14,460 --> 00:01:16,460 First of all, I'm going to say, Scott, welcome to the show. 18 00:01:16,460 --> 00:01:17,460 Great. 19 00:01:17,460 --> 00:01:18,460 Thank you for having me, Toyosi. 20 00:01:18,460 --> 00:01:19,860 I really appreciate it. 21 00:01:19,860 --> 00:01:22,480 So our audience would like to get to know you better. 22 00:01:22,480 --> 00:01:26,800 So if you would please introduce yourself, especially in the context of your career as 23 00:01:26,800 --> 00:01:29,020 a clinician scientist. 24 00:01:29,020 --> 00:01:32,020 Absolutely. 25 00:01:32,020 --> 00:01:35,140 So my background is, essentially, I went to the University of Scranton. 26 00:01:35,140 --> 00:01:37,460 I graduated there in 2006. 27 00:01:37,460 --> 00:01:43,340 And when I first started thinking about what I wanted to do with my career, I really was 28 00:01:43,340 --> 00:01:47,300 focused on a career in Madison. 29 00:01:47,300 --> 00:01:53,660 And I had a very series of really important experiences with the research that I had done, 30 00:01:53,660 --> 00:01:57,300 both the University of Scranton as well as summer research programs that got me interested 31 00:01:57,300 --> 00:02:00,220 in research we could talk about in a little bit as well. 32 00:02:00,220 --> 00:02:04,740 And I applied to the MD-PhD program at the University of Rochester, and I was there for 33 00:02:04,740 --> 00:02:08,600 eight years from 2006 to 2014. 34 00:02:08,600 --> 00:02:10,100 And then I came to the University of Pennsylvania. 35 00:02:10,100 --> 00:02:11,500 I've been here ever since. 36 00:02:11,500 --> 00:02:18,380 I did my internship and residency in internal medicine here at UPenn, followed by my fellowship 37 00:02:18,380 --> 00:02:20,620 in hematology and oncology. 38 00:02:20,620 --> 00:02:25,260 And I just started as a professor of medicine in the Department of Medicine or Division 39 00:02:25,260 --> 00:02:28,380 of Hematology and Oncology at UPenn here just this past July. 40 00:02:28,380 --> 00:02:34,420 So I have a brand new lab in which I study sickle cell disease and thalassemia and other 41 00:02:34,420 --> 00:02:35,420 hemoglobinopathies. 42 00:02:35,420 --> 00:02:40,180 And I see red cell disorders as well as adult patients with sickle cell disease and thalassemia 43 00:02:40,180 --> 00:02:42,020 in the clinic here at UPenn. 44 00:02:42,020 --> 00:02:46,660 And so I'm very excited to be able to share my journey through that whole process. 45 00:02:46,660 --> 00:02:51,500 But I really have tremendously privileged to be able to work with this very special 46 00:02:51,500 --> 00:02:56,460 group of patients, both in terms of the research that I do as well as the clinical care that 47 00:02:56,460 --> 00:02:58,340 I take care of too. 48 00:02:58,340 --> 00:02:59,780 Wow, Scott. 49 00:02:59,780 --> 00:03:06,580 One of the things I hear as you describe your journey is that that took a long time. 50 00:03:06,580 --> 00:03:13,780 Can you speak to how much time it takes and the fact that you're not yet there at the 51 00:03:13,780 --> 00:03:15,060 top of your career, right? 52 00:03:15,060 --> 00:03:17,940 You really are kind of still just starting out, even though you've been doing this for 53 00:03:17,940 --> 00:03:19,340 a while. 54 00:03:19,340 --> 00:03:24,860 Sometimes many early career faculty or fellows think, wow, if I really want to start in research 55 00:03:24,860 --> 00:03:30,420 and you actually had a chance to start a little bit earlier than most, what are some of the 56 00:03:30,420 --> 00:03:34,700 concerns and challenges and benefits of just thinking about how long it all takes? 57 00:03:34,700 --> 00:03:35,700 Yeah. 58 00:03:35,700 --> 00:03:37,740 I think that's a question I get asked a lot. 59 00:03:37,740 --> 00:03:42,420 I would say by people that I work with, but more so by family members saying, oh, you're 60 00:03:42,420 --> 00:03:43,420 still in training. 61 00:03:43,420 --> 00:03:46,420 And finally I can say, no, I've finally completed training. 62 00:03:46,420 --> 00:03:54,540 I think my perspective on the journey is that it is a long time, but I will say that the 63 00:03:54,540 --> 00:04:02,180 process is when I tell people that are looking for advice as to how to approach this long 64 00:04:02,180 --> 00:04:03,780 training process. 65 00:04:03,780 --> 00:04:08,260 I think getting early experiences, you mentioned, is really important because before you commit 66 00:04:08,260 --> 00:04:13,580 to a long term training program, particularly programs like MD-PhD that usually lasts at 67 00:04:13,580 --> 00:04:19,220 least eight years, four years of medical school, and then typically four to five years in a 68 00:04:19,220 --> 00:04:24,200 PhD, you want to make sure that you have had the kind of experiences that will prepare 69 00:04:24,200 --> 00:04:29,140 you for that journey and also to make sure that's what you want to do with your career. 70 00:04:29,140 --> 00:04:36,540 And it's hard to know initially, but I always tell my trainees to really try to get as much 71 00:04:36,540 --> 00:04:41,700 experience doing research in the lab during their undergraduate career. 72 00:04:41,700 --> 00:04:45,340 Some people will have longitudinal projects during their undergraduate career. 73 00:04:45,340 --> 00:04:48,980 Some people at small institutions like my own University of Scranton, I did research 74 00:04:48,980 --> 00:04:53,140 there, but also did summer programs at the University of Stony Brook and Princeton University. 75 00:04:53,140 --> 00:04:57,200 And so I got a variety of experiences and some people will take a gap year to be able 76 00:04:57,200 --> 00:05:01,740 to figure that out, one or two years in which they can do research as a technician, research 77 00:05:01,740 --> 00:05:06,300 technician in a laboratory or a more in-depth experience. 78 00:05:06,300 --> 00:05:09,500 And I think I usually tell people to, you know, you don't want to prolong the process 79 00:05:09,500 --> 00:05:14,340 any longer than is necessary, but you want to make sure that this is the right fit for 80 00:05:14,340 --> 00:05:15,580 you. 81 00:05:15,580 --> 00:05:21,420 And so I think as long as it is, as long as you've had those experiences shadowing in 82 00:05:21,420 --> 00:05:25,740 the clinic, as well as doing basic research or translational research in the lab, getting 83 00:05:25,740 --> 00:05:32,020 that hands-on experience, I view the time as more of a journey than actually having 84 00:05:32,020 --> 00:05:33,580 a definitive end point. 85 00:05:33,580 --> 00:05:38,340 Because ultimately, if it's really what you want to do with your career, the whole process 86 00:05:38,340 --> 00:05:44,300 is about getting those experiences, making connections, networking throughout your MD 87 00:05:44,300 --> 00:05:46,760 and your PhD time period. 88 00:05:46,760 --> 00:05:55,500 So I usually encourage people that I mentor to think of it as a process of really establishing 89 00:05:55,500 --> 00:05:59,100 your interest in your career as opposed to saying, I need to get this number of papers 90 00:05:59,100 --> 00:06:05,500 out or I need to get this kind of training from a resume standpoint. 91 00:06:05,500 --> 00:06:09,820 It's more about viewing it as a total journey, I would say. 92 00:06:09,820 --> 00:06:14,620 I appreciate your saying that because I think that when we look at it as a destination, 93 00:06:14,620 --> 00:06:18,140 then of course eight years is too long to get to a destination. 94 00:06:18,140 --> 00:06:22,460 But when you look at it as enjoying the journey, it's like, wow, I get eight years to really 95 00:06:22,460 --> 00:06:24,780 do this thing that I enjoy doing. 96 00:06:24,780 --> 00:06:30,620 And I love the way you talk about really making sure that this is what you want to do and 97 00:06:30,620 --> 00:06:32,280 then making a commitment, right? 98 00:06:32,280 --> 00:06:34,820 Because it is a commitment. 99 00:06:34,820 --> 00:06:38,020 And what you don't want to do is in the middle of all that say, well, I'm not sure this is 100 00:06:38,020 --> 00:06:39,700 what I wanted to do. 101 00:06:39,700 --> 00:06:43,220 I imagine, though, that you had challenges along the way. 102 00:06:43,220 --> 00:06:49,180 And I wonder at what point in your eight-year journey and beyond did you stop and say, I'm 103 00:06:49,180 --> 00:06:51,020 not sure this is for me? 104 00:06:51,020 --> 00:06:52,500 And what kept you going? 105 00:06:52,500 --> 00:06:53,500 Yeah. 106 00:06:53,500 --> 00:06:54,640 It's a great question. 107 00:06:54,640 --> 00:07:00,500 And I think everybody has during the process, these existential crises in some way and thinking, 108 00:07:00,500 --> 00:07:02,420 is this really what I want to do? 109 00:07:02,420 --> 00:07:04,900 Is this the career that I really want to pursue? 110 00:07:04,900 --> 00:07:11,540 I'll get to my experience in a minute, but I think the key part about understanding how 111 00:07:11,540 --> 00:07:15,940 to get through that is having the right mentorship and the right support around you. 112 00:07:15,940 --> 00:07:23,860 I think this process of being a clinician researcher is not a solo journey. 113 00:07:23,860 --> 00:07:26,580 It takes a whole team of people to be able to do that. 114 00:07:26,580 --> 00:07:31,500 So having mentorship along the way, I think some people who are maybe just starting the 115 00:07:31,500 --> 00:07:34,700 process might view it as, I need to do this on my own. 116 00:07:34,700 --> 00:07:35,700 I need to be strong. 117 00:07:35,700 --> 00:07:37,740 I need to figure everything else out by myself. 118 00:07:37,740 --> 00:07:40,700 And that is not, I would not recommend that. 119 00:07:40,700 --> 00:07:45,660 And it's also not the way that really science works, even when you get into faculty and 120 00:07:45,660 --> 00:07:46,660 collaborations. 121 00:07:46,660 --> 00:07:51,520 Really, it's all about having the right mentorship team and the right support team around you. 122 00:07:51,520 --> 00:07:56,900 So establishing that and keeping contact with different kinds of mentors along the process. 123 00:07:56,900 --> 00:08:01,540 Your person who is your primary research mentor will likely not be the same person that is 124 00:08:01,540 --> 00:08:06,300 your primary clinical mentor or your primary career mentor, or even your primary writing 125 00:08:06,300 --> 00:08:07,300 mentor. 126 00:08:07,300 --> 00:08:08,580 These could all be different people. 127 00:08:08,580 --> 00:08:12,540 And so having different people to go to with different kinds of challenges that you encounter 128 00:08:12,540 --> 00:08:13,820 is really critical. 129 00:08:13,820 --> 00:08:18,680 So I would strongly encourage your listeners to establish and ask for mentorship all along 130 00:08:18,680 --> 00:08:19,680 the way. 131 00:08:19,680 --> 00:08:24,460 And coming in, it's important when you have an internship to have an ask from that person, 132 00:08:24,460 --> 00:08:26,500 to not just say, can you be my mentor? 133 00:08:26,500 --> 00:08:31,300 You want to think about before you meet with that mentor and say, this is what I would 134 00:08:31,300 --> 00:08:37,260 be helpful to have from your mentorship process and your own experiences to help me continue 135 00:08:37,260 --> 00:08:38,540 along this whole process. 136 00:08:38,540 --> 00:08:41,060 And so that's really critical. 137 00:08:41,060 --> 00:08:46,800 My journey, I would say, is that I was very fortunate in my first rotation during my MD 138 00:08:46,800 --> 00:08:51,540 at the University of Rochester to find an incredible physician scientist mentor, Jim 139 00:08:51,540 --> 00:08:58,060 Pallas, who's a pediatric physician who cared for patients with different rare blood disorders 140 00:08:58,060 --> 00:09:03,660 and cancers clinically and studied aspects of the red blood cell and how it develops 141 00:09:03,660 --> 00:09:07,140 and the embryo and the fetus and eventually into adulthood. 142 00:09:07,140 --> 00:09:13,120 And so I was interviewed with him initially in my process moving to Rochester for the 143 00:09:13,120 --> 00:09:17,260 program and rotated with him first, ended up back in his lab for my thesis project. 144 00:09:17,260 --> 00:09:21,380 And he was an incredibly important mentor throughout the whole process to the point 145 00:09:21,380 --> 00:09:26,700 where I still collaborate and talk with him for larger big picture career mentorship still 146 00:09:26,700 --> 00:09:28,420 today. 147 00:09:28,420 --> 00:09:33,380 And I think there are time periods, right, during the transition processes, particularly 148 00:09:33,380 --> 00:09:37,720 for people doing MD-PhDs, where it can be really challenging. 149 00:09:37,720 --> 00:09:42,500 So I think when you're within the first two years of your MD program, things are pretty 150 00:09:42,500 --> 00:09:44,100 laid out for you. 151 00:09:44,100 --> 00:09:45,580 It's almost like going back to high school. 152 00:09:45,580 --> 00:09:47,060 You're all in one big room together. 153 00:09:47,060 --> 00:09:49,180 You have all your friends. 154 00:09:49,180 --> 00:09:50,180 You're meeting a lot of new people. 155 00:09:50,180 --> 00:09:51,660 You eat lunch together. 156 00:09:51,660 --> 00:09:52,660 It's very interesting. 157 00:09:52,660 --> 00:09:57,140 And then you leave your class after two years and you go to the PhD program. 158 00:09:57,140 --> 00:10:02,100 And so essentially all the connections you've made at a personal level go away in some way. 159 00:10:02,100 --> 00:10:05,340 And that could be really challenging for a lot of young trainees. 160 00:10:05,340 --> 00:10:10,620 And so establishing, having that longitudinal mentorship is really important at that stage 161 00:10:10,620 --> 00:10:15,780 and choosing a lab where you feel like it really aligns with not only your research 162 00:10:15,780 --> 00:10:23,220 interests, but your personal viewpoint as to how you want to approach science and medicine. 163 00:10:23,220 --> 00:10:27,060 That's hard to know at first, but going and doing rotations, going to lab meetings, meeting 164 00:10:27,060 --> 00:10:30,820 the people in your lab, seeing if that's the right fit for you is really critical. 165 00:10:30,820 --> 00:10:34,180 The other time period that can be challenging, I think, in terms of knowing whether it's 166 00:10:34,180 --> 00:10:39,360 the right thing to do or not is on the back end of the PhD, moving back to the medical, 167 00:10:39,360 --> 00:10:44,140 the third and fourth year of medical school, in which everything, essentially at the end 168 00:10:44,140 --> 00:10:49,260 of your PhD, you are really the expert in the world probably in your small niche of 169 00:10:49,260 --> 00:10:51,840 what you're working on in the lab. 170 00:10:51,840 --> 00:10:57,260 And then you go back to third year of medicine where you know nothing essentially about all 171 00:10:57,260 --> 00:10:59,060 the rotations that you're doing. 172 00:10:59,060 --> 00:11:00,580 And I think it can be really challenging. 173 00:11:00,580 --> 00:11:06,300 I distinctly remember, it's very challenging when you are on a rotation in which you have 174 00:11:06,300 --> 00:11:12,180 patients that are very ill, because I think, particularly as a scientist, you want to be 175 00:11:12,180 --> 00:11:19,380 able to have a significant degree of planning and control over what you're doing and your 176 00:11:19,380 --> 00:11:24,940 research and overall, and things happen clinically that are unpredictable. 177 00:11:24,940 --> 00:11:32,420 And so having support around you to be able to talk to your co-medical students, having 178 00:11:32,420 --> 00:11:36,940 program mentors to get through some of these more challenging patient encounters where 179 00:11:36,940 --> 00:11:40,900 no matter what you do, even if you're the best clinician in the world, some of these 180 00:11:40,900 --> 00:11:43,940 patients become very, very ill and even die. 181 00:11:43,940 --> 00:11:49,700 And so this can be very challenging, I think, for people who are doing MD-PhD programs or 182 00:11:49,700 --> 00:11:56,180 MD with research, because it's a very different approach to your daily job and to how you're 183 00:11:56,180 --> 00:11:59,760 approaching science and medicine between the two. 184 00:11:59,760 --> 00:12:02,980 And having that experience early, everybody goes through it at some point. 185 00:12:02,980 --> 00:12:03,980 It's normal. 186 00:12:03,980 --> 00:12:08,860 I just want your listeners to know it's very normal to be face to that challenge and struggle 187 00:12:08,860 --> 00:12:09,860 somewhat through it. 188 00:12:09,860 --> 00:12:14,140 But having that mentorship and knowing that others have gone through it before you is 189 00:12:14,140 --> 00:12:18,140 really the most important thing to be able to weather these transitions and to continue 190 00:12:18,140 --> 00:12:20,460 on your career. 191 00:12:20,460 --> 00:12:21,540 That's really excellent. 192 00:12:21,540 --> 00:12:23,020 Thank you for highlighting all those things. 193 00:12:23,020 --> 00:12:27,540 So one of the things that kind of like a big theme of what I hear you talking about is 194 00:12:27,540 --> 00:12:28,540 community. 195 00:12:28,540 --> 00:12:32,100 And that's community and the people who surround you when you're going through different phases 196 00:12:32,100 --> 00:12:36,580 of your training, and also community and the mentors that lead you along the way and guide 197 00:12:36,580 --> 00:12:38,900 you along the way. 198 00:12:38,900 --> 00:12:43,420 And in your journey, as you were talking about how you never did it by yourself and you don't 199 00:12:43,420 --> 00:12:48,020 encourage anybody to do it by themselves, and I do think isolation can be a challenge, 200 00:12:48,020 --> 00:12:52,300 because you mentioned at the end, someone else has gone through the same problem. 201 00:12:52,300 --> 00:12:56,440 When we're going through a challenge, especially when research is not working or projects are 202 00:12:56,440 --> 00:13:01,340 not going as you want them to, there's this sense that I'm the only one in the world to 203 00:13:01,340 --> 00:13:04,220 whom this has ever happened and therefore I quit. 204 00:13:04,220 --> 00:13:07,760 And being able to talk to someone else, even if they can't help you, for them to be able 205 00:13:07,760 --> 00:13:12,380 to say, oh, I experienced this as well, already normalizes your experience and it makes a 206 00:13:12,380 --> 00:13:13,380 difference as well. 207 00:13:13,380 --> 00:13:14,380 Yeah. 208 00:13:14,380 --> 00:13:19,700 And if I could just add to that part too, I think that that's a, I'd say particularly 209 00:13:19,700 --> 00:13:23,500 when you make the transition to the next phase of training and residency, internship and 210 00:13:23,500 --> 00:13:30,540 residency and fellowship, if you don't have that support system and ask others for help, 211 00:13:30,540 --> 00:13:34,520 burnout is a really big problem in medicine and in science. 212 00:13:34,520 --> 00:13:38,020 And so if you're trying to do both, it can be very challenging. 213 00:13:38,020 --> 00:13:44,260 And so I think one of the, one of the, my most, I think the best parts about being a 214 00:13:44,260 --> 00:13:50,220 clinician researcher is that you have people on both sides of the community to help support 215 00:13:50,220 --> 00:13:51,220 you through that. 216 00:13:51,220 --> 00:13:53,160 You have the scientists, you have the clinicians. 217 00:13:53,160 --> 00:13:58,620 You can go to either one, depending on what, what you're struggling with or what the challenge 218 00:13:58,620 --> 00:14:03,940 is at any given point in a daily basis or in a career phase basis. 219 00:14:03,940 --> 00:14:10,820 And I think that the, the most useful thing is if something is, if you have a very challenging 220 00:14:10,820 --> 00:14:14,080 days, for example, it'd be really challenging patients on service. 221 00:14:14,080 --> 00:14:20,320 You can go back to lab and, and ask questions kind of to, to transition back and forth between 222 00:14:20,320 --> 00:14:24,620 the two can be very challenging, I think, but it can also be somewhat of a respite on 223 00:14:24,620 --> 00:14:28,500 both sides because you could have a very challenging patients and do some experiments in lab and 224 00:14:28,500 --> 00:14:29,500 vice versa. 225 00:14:29,500 --> 00:14:33,280 You can be really frustrated with where your research is going and you could take up a 226 00:14:33,280 --> 00:14:38,060 whole new direction or, you know, really focus on the clinical aspects of your work for a 227 00:14:38,060 --> 00:14:39,060 period of time. 228 00:14:39,060 --> 00:14:45,260 And I think that's really one of the best antidotes to burnout that I've seen in people 229 00:14:45,260 --> 00:14:49,060 who are successful in pursuing a career as a clinician researcher. 230 00:14:49,060 --> 00:14:55,580 Absolutely. So what I hear is that in a sense, your frustrations can become an advantage. 231 00:14:55,580 --> 00:14:59,420 How do you take the frustrations that you see in the clinical space and think about 232 00:14:59,420 --> 00:15:05,700 how to best answer questions in the, in the research space when research is not working, 233 00:15:05,700 --> 00:15:09,820 looking to your patients kind of as a source of inspiration for where the next place, the 234 00:15:09,820 --> 00:15:11,220 next step might lead. 235 00:15:11,220 --> 00:15:16,580 Yeah, absolutely. I think this is that, and, and, you know, I'm, I'm a classical hematologist, 236 00:15:16,580 --> 00:15:22,380 so I study non-cancer blood disorders. And I think there's a long and storied history 237 00:15:22,380 --> 00:15:29,540 of this approach in hematology. You know, if you look back at to really all of the major, 238 00:15:29,540 --> 00:15:36,480 the giants in classical hematology ran labs and, and also saw patients and their clinical 239 00:15:36,480 --> 00:15:41,180 care and the observations they made on the clinical side really informed almost everything 240 00:15:41,180 --> 00:15:47,620 and what they did on the research side. And so I think for some period of time that, that 241 00:15:47,620 --> 00:15:53,540 approach went away, but I feel like it's returning now, especially with a lot of the really advanced 242 00:15:53,540 --> 00:15:57,940 genetic techniques that we can have where for a while we would, as hematologists look 243 00:15:57,940 --> 00:16:02,700 for syndromes and syndromal presentations and understand how that works. Now we can 244 00:16:02,700 --> 00:16:08,980 take patients that are very, very potentially ill and complicated diseases, understand their 245 00:16:08,980 --> 00:16:12,700 genetics better on the clinical side, and then apply that to the work that we're doing 246 00:16:12,700 --> 00:16:17,340 in the lab. And I think that there's nowhere else that that is more evident than one of 247 00:16:17,340 --> 00:16:21,180 the main things that I do, which is studying sickle cell disease. We've known for many 248 00:16:21,180 --> 00:16:26,300 years, one of the things that I study in lab is trying to increase levels of a protective 249 00:16:26,300 --> 00:16:30,820 form of hemoglobin, something called fetal hemoglobin. And this is, it is resistant to 250 00:16:30,820 --> 00:16:35,360 the sickling effects that, that are present in sickle cell disease. And so if we can find 251 00:16:35,360 --> 00:16:40,300 ways to increase levels of this subtype of hemoglobin, then we can really treat patients 252 00:16:40,300 --> 00:16:45,180 very effectively. And we know that there are certain patients who have genetic changes 253 00:16:45,180 --> 00:16:51,500 that have higher levels of fetal hemoglobin at baseline. And that leads to essentially 254 00:16:51,500 --> 00:16:56,580 have them having a much more reduced density and frequency of pain episodes and many, many 255 00:16:56,580 --> 00:17:02,060 fewer complications. And only recently we have identified the genetic basis behind those 256 00:17:02,060 --> 00:17:06,940 where they're actually changing the ways that certain regulators are expressing levels of 257 00:17:06,940 --> 00:17:11,500 fetal hemoglobin or pressing their expression. And so it's really exciting. I think that's 258 00:17:11,500 --> 00:17:16,220 something that people have identified for many, many years, for example, in sickle cell disease. 259 00:17:16,220 --> 00:17:20,780 We're finally understanding now what is the genetic basis behind that. And we, and we 260 00:17:20,780 --> 00:17:25,540 use some of those observations that we see on the clinical side to really drive our scientific 261 00:17:25,540 --> 00:17:27,460 research. 262 00:17:27,460 --> 00:17:35,340 It's really exciting. And at the very beginning, you use the C word. You use the classical, 263 00:17:35,340 --> 00:17:40,260 you said classical hematology, which is the official term. I, I wouldn't say there's some 264 00:17:40,260 --> 00:17:44,780 debate I would say I would, I would be one of those people in the debate. But yeah, so 265 00:17:44,780 --> 00:17:47,860 it was interesting. I was going to ask you if you, if you would call yourself a classical 266 00:17:47,860 --> 00:17:53,220 hematologist, I know our audience is not necessarily specifically hematology, but would you speak 267 00:17:53,220 --> 00:17:59,260 to that? Would you speak to kind of the challenges and nomenclature, but, but deep more deeply 268 00:17:59,260 --> 00:18:04,260 the challenges and recruiting faculty to classical hematology? What, what is that about from 269 00:18:04,260 --> 00:18:07,420 your perspective? How do we change that? 270 00:18:07,420 --> 00:18:14,060 Absolutely. So I think, I think as I mentioned, as I mentioned initially, a lot of the initial 271 00:18:14,060 --> 00:18:19,100 seminal work and the giants in the field and hematology were done in the field of what 272 00:18:19,100 --> 00:18:22,900 do you want to call it? Classical hematology, benign hematology is how I was trained, but 273 00:18:22,900 --> 00:18:26,860 people don't really, these aren't benign disorders, right? They're really significant or just 274 00:18:26,860 --> 00:18:31,740 hematology, but that gets to be a little bit confusing. So, and, and I think with the advent 275 00:18:31,740 --> 00:18:37,860 of the tremendous amount of anti-cancer therapies that were emerged in the nineties and early 276 00:18:37,860 --> 00:18:42,820 two thousands, a lot of the focus and people that were interested in hematology went to 277 00:18:42,820 --> 00:18:50,780 the malignant hematology side. And so I think a lot of our most talented trainees in that 278 00:18:50,780 --> 00:18:57,180 period of time were recruited over to, to malignant hematology. I consider that as well, 279 00:18:57,180 --> 00:19:01,340 you know, until I came, until I came to Penn and started my fellowship and I had, you know, 280 00:19:01,340 --> 00:19:08,300 tremendous mentors here. So in particular, Dr. Charles Abrams, who is a long time faculty 281 00:19:08,300 --> 00:19:13,060 here in Leeds, a lot of the research efforts and really a fantastic hematologist and, and 282 00:19:13,060 --> 00:19:18,220 Dr. Joel Bennett, who recently passed, was a really a giant in the field of hemostasis 283 00:19:18,220 --> 00:19:23,100 thrombosis here at Penn, were both tremendous mentors to me. And they, I think it really 284 00:19:23,100 --> 00:19:31,960 appealed to me in terms of, of classical hematology, that you can study something that is fascinating 285 00:19:31,960 --> 00:19:39,060 from a biological perspective across the lifespan and, and also have the kind of relationship 286 00:19:39,060 --> 00:19:44,340 that primary care doctors have with their patients. And so that combination of things, 287 00:19:44,340 --> 00:19:50,060 the, the really the chronic, chronic care of a serious disease and the deep relationships 288 00:19:50,060 --> 00:19:56,820 with patients and studying really fascinating biology drew me to, to hematology. And so, 289 00:19:56,820 --> 00:20:01,460 but I would say not a lot of, you know, it gets changing now because we have some really 290 00:20:01,460 --> 00:20:07,220 exciting new therapies coming out in the hemoglobinopathy space, particularly with gene therapy, with 291 00:20:07,220 --> 00:20:11,660 sickle cell disease and thalassemia, which has fascinating biology behind it and getting 292 00:20:11,660 --> 00:20:15,780 a lot of people interested in it, but, and newer therapies that are being developed, 293 00:20:15,780 --> 00:20:20,620 of which I study, you know, the kind of pharmacologic, I, inducers of fetal hemoglobin in different 294 00:20:20,620 --> 00:20:24,980 signaling pathways in the treatment of sickle cell disease, but it's still challenging 295 00:20:24,980 --> 00:20:30,580 to recruit people. I will say that that, that has changed in the last several years in which 296 00:20:30,580 --> 00:20:34,500 we've gotten many more residents that are applying into the program that are interested 297 00:20:34,500 --> 00:20:38,460 in classical or benign hematology. And that's really exciting for the field, but there's 298 00:20:38,460 --> 00:20:47,300 still a tremendous shortage of physicians that are trained in this field. And so I think 299 00:20:47,300 --> 00:20:54,700 we as clinician researchers really need to be able, need to advocate for our work and 300 00:20:54,700 --> 00:21:00,340 to talk. I feel like we are really good at talking to other specialists in the field 301 00:21:00,340 --> 00:21:06,100 about, you know, the latest paper that's come out describing the newest signaling pathways 302 00:21:06,100 --> 00:21:12,780 and sickle cell disease, but we are, I would say generally less adept at describing this 303 00:21:12,780 --> 00:21:19,580 to in a way that helps recruit younger trainees to the field. And there's, it really depends 304 00:21:19,580 --> 00:21:23,100 on the audience, right? So you have to try to figure out, I don't want to say to be a 305 00:21:23,100 --> 00:21:29,420 salesman, but you want it to show why you fell in love with this deal in the first place. 306 00:21:29,420 --> 00:21:33,860 And so I think trying to use as many outlets as possible to do that, you know, whether 307 00:21:33,860 --> 00:21:37,460 it's through publications, which is really critical for what we do in the lab, but also 308 00:21:37,460 --> 00:21:42,940 through social media platforms, through giving talks, through community organizations, you 309 00:21:42,940 --> 00:21:47,980 know, this, this month is September is Sickle Cell Awareness Month. And so we are, have 310 00:21:47,980 --> 00:21:52,980 a lot of outreach programs for both the patient level and the community level to talk about 311 00:21:52,980 --> 00:21:58,180 what we do. And I think the more interest that there is, and the more we talk about 312 00:21:58,180 --> 00:22:04,980 our work in a way that makes it equally exciting for others who may not be in our exact field, 313 00:22:04,980 --> 00:22:11,700 the more that we can recruit and have people really join us on this journey to treat patients 314 00:22:11,700 --> 00:22:16,300 across the whole lifespan with these really chronic and debilitating disorders that maybe 315 00:22:16,300 --> 00:22:22,820 aren't as historically as interesting to people as malignancies in cancer, but are equally, 316 00:22:22,820 --> 00:22:26,900 equally compelling and even more so, I would argue in a biological sense and desperately 317 00:22:26,900 --> 00:22:30,860 needed to be able to care for this really underserved population. 318 00:22:30,860 --> 00:22:38,660 Absolutely. And I think that a lot of upcoming fellows or junior faculty may not have the 319 00:22:38,660 --> 00:22:42,940 role models or mentorship that allows them to continue these interests. But I love what 320 00:22:42,940 --> 00:22:48,700 you talk about in advocating for our own careers, like where we're responsible. And so sometimes 321 00:22:48,700 --> 00:22:54,140 it is easier to say, well, this is what I have around me. I'll just go with the flow. 322 00:22:54,140 --> 00:22:57,980 It's harder is to say, this is what I really want to do and who can help me get there. 323 00:22:57,980 --> 00:23:02,980 I was going to say, I think doing this early in the career is really helpful too. I've 324 00:23:02,980 --> 00:23:09,500 been doing this, my wife is incredibly talented, a high school teacher at a private school 325 00:23:09,500 --> 00:23:14,260 west of Philadelphia. And I go every year and talk to the students there to try to tell 326 00:23:14,260 --> 00:23:18,900 them about all the exciting things I'm doing in hematology and just in general medicine 327 00:23:18,900 --> 00:23:24,060 and try to make it interactive about all the different aspects of being a physician, scientist, 328 00:23:24,060 --> 00:23:30,100 and all the levels of what you can do with training, whether it's doing MD and doing 329 00:23:30,100 --> 00:23:34,100 a significant research experience or doing MD PhD. And it's really been very rewarding 330 00:23:34,100 --> 00:23:40,160 because I think I had not even heard the words MD PhD before I got to college. And I see 331 00:23:40,160 --> 00:23:45,420 students really light up when they see this because I think they are interested in caring 332 00:23:45,420 --> 00:23:51,460 for people and medicine. And I think they also are stimulated by a lot of the science 333 00:23:51,460 --> 00:23:58,420 that they're learning through my wife's classes and through other classes that they hear about 334 00:23:58,420 --> 00:24:03,180 in high school. And the fact that they might be able to do this combination of things in 335 00:24:03,180 --> 00:24:08,260 a career, I think is something that the earlier that we talk to students about these kinds 336 00:24:08,260 --> 00:24:13,100 of pathways, the better. Not just hematology really in general, but I will advocate for 337 00:24:13,100 --> 00:24:14,820 my field as well. 338 00:24:14,820 --> 00:24:20,380 Absolutely. So we're coming up to the end of the show. And I want to ask, because one 339 00:24:20,380 --> 00:24:25,340 thing you spoke to that does resonate with me is the importance of early exposure. But 340 00:24:25,340 --> 00:24:31,300 for many junior faculty, even early career faculty who haven't had the research experiences 341 00:24:31,300 --> 00:24:36,260 or the research exposure that's needed, there's sometimes a sense that it's too late. All 342 00:24:36,260 --> 00:24:42,700 I have is clinical experience. I guess I'll just stay with clinical and not move into 343 00:24:42,700 --> 00:24:48,620 research. I want you to speak to like, when is it too late to pursue a research career? 344 00:24:48,620 --> 00:24:53,500 And for someone who's starting late in the game, what strategies might they use potentially 345 00:24:53,500 --> 00:24:54,500 to be successful? 346 00:24:54,500 --> 00:25:01,420 Yeah, it's a really, really important question. I think that from a research perspective, 347 00:25:01,420 --> 00:25:06,300 and I think you don't really realize this until you start running a lab, most by far, 348 00:25:06,300 --> 00:25:12,820 the most important quality of somebody that is interested in pursuing research is being 349 00:25:12,820 --> 00:25:19,060 interested and motivated in doing the research. I think a lot of, as you mentioned, a lot 350 00:25:19,060 --> 00:25:24,100 of people will say, oh, I don't know how to do this certain technique. I'm not sure I 351 00:25:24,100 --> 00:25:28,300 don't have the necessary the skills to be able to do that. You're bringing a different 352 00:25:28,300 --> 00:25:32,140 perspective. So if you're a clinician that's interested in getting into research, the kinds 353 00:25:32,140 --> 00:25:37,300 of experience that you have taken care of patients, the kinds of questions you can ask 354 00:25:37,300 --> 00:25:43,020 is incredibly valuable for any lab that's out there because you can design and think 355 00:25:43,020 --> 00:25:48,940 about questions that somebody who is not clinically trained would never think of. And so that's 356 00:25:48,940 --> 00:25:56,660 an incredible value addition for the lab. And you can learn the techniques. So for instance, 357 00:25:56,660 --> 00:26:01,220 and I experienced this myself going off to residency and then coming back to the lab, 358 00:26:01,220 --> 00:26:06,100 there's a lot of changes in science in that five or six years. You know, CRISPR technology 359 00:26:06,100 --> 00:26:10,780 didn't exist when I finished my PhD. And I came back and there's all kinds of complicated 360 00:26:10,780 --> 00:26:14,260 techniques and I learned it. And that's what I use at a daily basis in my lab right now. 361 00:26:14,260 --> 00:26:21,980 And so I think there's it's really not too late to pursue research because the experience 362 00:26:21,980 --> 00:26:28,180 you've had up to that point are absolutely going to be incredibly beneficial and valued 363 00:26:28,180 --> 00:26:34,940 by the group that you're in. I think that the question about how to how to get that 364 00:26:34,940 --> 00:26:41,420 experience later on, I would say that this comes down to mentorship as well. You know, 365 00:26:41,420 --> 00:26:46,900 talking to, for example, your your primary clinical mentor or your the chief of your 366 00:26:46,900 --> 00:26:51,420 division or subdivision at your institution, they've interacted with a lot of people. And 367 00:26:51,420 --> 00:26:55,020 even if they're not a basic scientist, they know people who are and they know people who 368 00:26:55,020 --> 00:27:00,580 are presented at different scientific presentations in your division. So one way would be to speak 369 00:27:00,580 --> 00:27:06,580 with them. Another would be to try to start going to some of the sessions and talks both 370 00:27:06,580 --> 00:27:11,460 by people internally as well as invited speakers, because the more you hear about different 371 00:27:11,460 --> 00:27:15,100 kinds of techniques and different kinds of research, even if it doesn't seem like it's 372 00:27:15,100 --> 00:27:18,620 directly related to what you're interested in the field, the more connections you can 373 00:27:18,620 --> 00:27:24,300 make to be able to to get into that that aspect. So I would say that if you feel like you have 374 00:27:24,300 --> 00:27:29,020 a passion for performing research, whether it's really anywhere in the spectrum, clinical, 375 00:27:29,020 --> 00:27:34,420 translational or basic science, identifying mentors and asking if you can participate 376 00:27:34,420 --> 00:27:39,180 in a project and getting that experience is really critical. And people very rarely will 377 00:27:39,180 --> 00:27:44,540 say no to you because they recognize good mentors will recognize the value of the training 378 00:27:44,540 --> 00:27:49,360 you've had thus far in your career. And you both benefit from that kind of collaboration 379 00:27:49,360 --> 00:27:52,900 and work in the research side of the lab. 380 00:27:52,900 --> 00:27:57,460 I love it. If you're interested, that may be the most important quality you have your 381 00:27:57,460 --> 00:28:02,300 interest and motivation and connect to community. And if you don't know a research community 382 00:28:02,300 --> 00:28:07,620 that you can connect to, there are other people who can connect you. I love it. Well, thank 383 00:28:07,620 --> 00:28:12,740 you, Scott. You just shared some amazing insights today. And I feel like it's I mean, I'm not 384 00:28:12,740 --> 00:28:17,540 starting right now. But if I was, it would it would be very just inspiring to hear you 385 00:28:17,540 --> 00:28:22,340 speak about how it's not too late. And I really do appreciate you sharing your insights. I 386 00:28:22,340 --> 00:28:25,020 wonder if you have any closing thoughts that you want to share? 387 00:28:25,020 --> 00:28:29,220 Yeah, I thank you, twice, for having me on. And I really appreciate it. And I I would 388 00:28:29,220 --> 00:28:35,340 say that I think my my closing thought and recommendation would be really try to get 389 00:28:35,340 --> 00:28:41,580 as as many experiences as you can along the whole journey. You know, oftentimes the most 390 00:28:41,580 --> 00:28:50,940 useful and important aspects of what have led me to my current interests are our experiences 391 00:28:50,940 --> 00:28:56,260 that may not seem directly relevant at the time. But you know, especially when you're 392 00:28:56,260 --> 00:29:02,860 training saying yes to different experiences, to giving invited talks to networking is really, 393 00:29:02,860 --> 00:29:08,920 really critical. So I can't I can't overstate the importance of making connections throughout 394 00:29:08,920 --> 00:29:13,060 your whole process, because the connections that I made during my PhD, I still use today, 395 00:29:13,060 --> 00:29:17,820 and are incredibly important for collaborations on my ongoing work. So I would say, you know, 396 00:29:17,820 --> 00:29:24,180 being being active, being engaged, network strongly and make lots of connections and 397 00:29:24,180 --> 00:29:28,900 really try and go out on go on a limb and try new experiences, because that's where 398 00:29:28,900 --> 00:29:35,060 the most important experiments aspect to your career, career development, and really understanding 399 00:29:35,060 --> 00:29:39,300 who you are as a clinician scientist. That that is where that happens when you kind of 400 00:29:39,300 --> 00:29:41,860 move outside your comfort zone. 401 00:29:41,860 --> 00:29:46,440 I love it. Thank you, Scott. All right, everyone, you've heard him. If this is what you want 402 00:29:46,440 --> 00:29:51,380 to do, you should pursue it. And it doesn't mean it'll be easy. But what you are interested 403 00:29:51,380 --> 00:29:57,220 in is worth fighting for. And so definitely someone else needs to hear this either a peer 404 00:29:57,220 --> 00:30:04,500 mentor or mentee or perhaps you want to share it with your group, please do it as somebody 405 00:30:04,500 --> 00:30:10,060 else needs to hear this and definitely be encouraged in their career. Scott, thank you 406 00:30:10,060 --> 00:30:14,180 again for being on the show. Thank you very much for having me. All right, everyone. We'll 407 00:30:14,180 --> 00:30:23,900 see you again next time. 408 00:30:23,900 --> 00:30:29,260 Thanks for listening to this episode of the clinician researcher podcast, where academic 409 00:30:29,260 --> 00:30:34,660 clinicians learn the skills to build their own research program, whether or not they 410 00:30:34,660 --> 00:30:40,220 have a mentor. If you found the information in this episode to be helpful, don't keep 411 00:30:40,220 --> 00:30:46,900 it all to yourself. Someone else needs to hear it. So take a minute right now and share 412 00:30:46,900 --> 00:30:53,420 it. As you share this episode, you become part of our mission to help launch a new generation 413 00:30:53,420 --> 00:31:10,660 of clinician researchers who make transformative discoveries that change the way we do healthcare.