david: this is my kitchen table and also my filing system. over much of the past three decades i have been an investor. the highest calling of mankind i've often thought was private equity. then, i started interviewing. i watch her interview so i know how to do interviews. i've learned from doing my interviews how leaders make it to the top. >> i asked how much he wanted, he said 250, i said fine and did not negotiate and did no due diligence. david: i have something i'd like to sell. and how they stay there. you don't feel inadequate being only the second wealthiest man in the planet, is that right? one of everyone's greatest fears is that he or she might be diagnosed at some point in their life with cancer. i had a chance to talk with dr. vickers who runs the memorial sloan-kettering cancer center. i had a chance to talk with him about the progress being made in treating cancer. david: today we are more than 50

years after president nixon declared war on cancer. have we made that much progress in the 50 years since he first declared war on cancer? dr. veckers: i think we have. the ability for someone who has a diagnosis of cancer broadly thinking about having a chance of cure has significantly improved. we've gone from all cancer diagnoses from the time of that announcement that was around 30% to 40% chance of cure. we are approaching 68% to 70% of patients across the board who get the diagnosis of cancer have a chance at five years to being told they don't have a tumor. david: what is the best way to avoid getting cancer? that's a question everybody asks , but what is the answer? dr. vickers: the best way to avoid it is healthy lifestyles, avoid smoking, limit red meat, the amount that you eat, all of these statements are no

guarantee he won't get cancer, but we do know to some degree they have a role in accelerating or increasing risk. in general, there is no actual way to prevent it. there are certain things we do to screen early. and if we catch cancers early, we have a good chance of curing them. david: what extent is environmental factors, behavioral and genetic that causes cancers? dr. vickers: it's a combination. there is a strong percentage of inherited genes that put you at risk. the most common is brca when into of women with breast cancer and increasing risk of ovarian cancer and to others. those we know and can detect. there are other genes that are passed on that significantly increase your risk, but that's a small number. the other genetic aspects are genetic mutations that are over time because of environment and age. those somatic mutations caused by viruses and cells that are

not correcting themselves, certainly have a role in producing malignant cells that grow uncontrolled. then, i think there is environmental exposures. we are learning more, we know there are ones for chemicals that do it. but the biggest contributor is aging that has a factor. david: what is the most common cancer, lung cancer, breast cancer, pancreatic cancer, brain cancer, what is the most common? dr. vickers: the most common cancers in america are breast and prostate. 300,000 cases of breast, 280,000 cases of prostate. lung is one of the most, if not, the number one killer. 150,000 cases, but it is the most lethal large number. pancras cancer, the incidence has increased. when i began my practice there

was 30,000 cases a year on average, now there over 65 thousand cases of pancreatic cancer a year. it's approaching a level where it's going to be the second most common killer of patients with cancer, even though it doesn't have the numbers like breast cancer. we can cure well over 90% of breast cancers and well over 95% of prostate cancers. david: with respect to prostate cancer, there is a psa, which is a blood marker, but we don't have those kind of things for pancreatic cancer. dr. vickers: we don't. there are clearly tests being involved based on being able to detect circulating tumor dna and other markers, and the ability to have broader ability to manage the data through computation oncology that are giving us gradual insight for early detection. it's not as specific as we want

and it's not as accurate. sometimes if i get a positive test, i really don't know which tumor to look for. sometimes it does give directions, but that's evolving. but you are right, we have psa's, mammograms, colonoscopy, cervical screening for certain cancers and ct scans for lungs. but we don't have broad availability of screening for a large number of cancers that are still killers. david: the type of cancers that are killers are ones where you don't know until may be stage iv, glioblastoma's, brain cancers, pancreatic cancer, may be liver cancer. how do you know if you have one of those cancers? what is the best way to go in for an annual cancer checkup or what do you do? >> it's hard and that is a question that has perplexed me. i would love to say, go get a cat scan for everybody. we can't do that, we don't have enough cap scanners to screen. we need a better ability to

enrich who's at risk. recent studies with ai have begin to predict who in the population by virtue of a number of things that they have pulled together, medical history, blood tests, who's at risk for pancreatic cancer. we do know now if you are a smoker, a certain age were exposed to smoke and you are over 50, you should get a low dose, which is proven to have a significant difference in outcome and detect early cancers. only about 6% to 8% of eligible people take advantage of that cat scan. i think it's coming, david, that ai programs looking at data can enrich the population who we know may be at risk. and the ones doing that, probably getting a scan, mri or ct scan, you can do for everybody but you could do for a select population. david: pancreatic cancer is the

disease ruth bader ginsburg died from. you don't typically know you have it until stage iv. you are a pancreatic cancer surgeon. why did you decide to specialize in that area? dr. vickers: a couple of things. at the time that i trained at johns hopkins, we were the leading center for treating patients with pancreatic cancer. as you talked about at that time, the leading opportunity to make a difference in somebody's life was surgery. number one, i felt i had a great training and had capacity to make a difference by virtue of that skill set. the environment, the leaders who encouraged us to look at difficult problems. one, it was a skill set of training. i was at a center where we focused and it was a problem that really needed the attention to make a difference. i soon learned as a surgeon after i did my first one hundred patients for pancreatic cancer successfully operating on them,

i could count on one hand how many were alive in five years. i knew it was a bigger problem than just my surgical skills are resolved. david: i'm always worried about pancreatic cancer as well. what's the best sign i might be having pancreatic cancer? dr. vickers: the signs are cancer are often due to something simple. but if you were to think about the things you might worry about, particularly as you get older, we don't naturally just lose weight when we get older. so a sudden weight loss. you want to ask the question, why am i dropping weight even though i have been tried for the last five years had nothing happen. new onset diabetes at for some reason now, i don't have a history of it, i'm over 65 and i'm developing diabetes. then subtly, although not early on, it's a case where either somehow my urine turns darker i

begin to have shades of change in my eyes are my thumbnails that begin to look a bit of yellow, what we call, jaundice. david: you call weight loss a sign of something not good. ozempic, which is now a very popular drug to reduce weight, some people said it might cause some type of tumors. are you an advocate of ozempic for everybody or for some people? dr. vickers: i think as the new glp-1 inhibitors, which are these drugs that really affect how we feel about being full become further advanced, i think it's going to be an overall seachange for american health care, including cancer. because we know obesity, over time, has significant impact in increasing cancer rate and risk. i don't have a strong opinion about whether ozempic or montero would cause a cancer, but i think the global impact is one

to reduce the overall health burden, including cancer. ♪

david: talk about your background. where were you born? dr. vickers: i was born in a small town in alabama. a small town in the black belt of alabama. a rural farming area. where my parents were educators. david: your parents were extremely well educated for blacks in the south at that point. how did they get so well educated? dr. vickers: on my father's side, it was really parents who had limited education. my grandfather with a fourth-grade education. he did not learn how to write and read until he was in his 40's. he really felt his children needed a college education. on my mother's side, her mother, in the 1920's, had to travel 200 miles to an academy started by presbyterians in the southern part of alabama to get her high school degree. they went 10 summers to get her

bachelors degree. they had foundations of understanding the value of education and the ability, particularly for a negro in the south to have a chance to advance their lives and careers. david: when you grow up in a segregated environment, you were the only child of your parents and did they say, we are putting all our hope in you and we want you to be a pancreatic cancer surgeon? dr. vickers: they had no clue what i would be. i think they wanted me to be the best i could be in anything i took my interest in. clearly achievement in high school and undergrad was really the first thing that they looked for an expected of me. and i tried to do that because i realized the legacy of both grandparents and even both great-grandparents had studied with booker t. washington that i had a significant responsibility. david: were you a superstar in high school? dr. vickers: i was a good

student. i grew up in a town called huntsville. it really offered the best education that i could get in alabama at the time. but when i arrived at johns hopkins i was probably behind 95% of my classmates. david: you must've done ok at johns hopkins undergrad because he got into medical school. dr. vickers: i had to catch up. it took me about a year to catch up. there were classes my classmates had who went to prep schools that i was taking for the first time. i hadn't had calculus when i arrived and they all had calculus. the leveling of the playing rome took a year for it to occur. once the playing ground became level i found that i could could pete as well as they could. david: when he went to johns hopkins medical schools, one of the most famous medical schools in the country, was it integrated at the time are mostly white? dr. vickers: there was a surgeon there who was from alabama, levi watkins, who became a mentor and

friend. he grew up in alabama where my grandmother and my mother went to the college where his father was president. levi went to tennessee state vanderbilt, then johns hopkins. stayed on faculty. the challenge of johns hopkins was that it clearly needed to be more diverse. he wrote all of the african-american applicants in the country and encourage them to apply to johns hopkins. and he provided a platform for people like me to have a interest in going. david: what did you do after graduation? dr. vickers: i made the transition and realize i wanted to be a surgeon, decided to stay in baltimore because i thought hopkins had the best surgical training of that time. david: ultimately went back to alabama. dr. vickers: that was a hard decision. i had an offer to stay on faculty. i had been in baltimore for 16 years and briefly accepted a job to stay but then changed my mind to go to alabama in part because

i felt i wanted to go back home to a new environment. david: is a great surgeon sometimes you might say i don't need to go into administrative parts of hospitals, i just wanted to do surgeries. route prompted you out of doing surgery to be an administrator at a hospital leader? dr. vickers: i think it was watching others who did it well. i had a dean who recruited me from birmingham, alabama to minneapolis, minnesota. which is a big jump to convince me to move my family. but she did several things that showed me the power of a leader at a significant level to affect the career of other leaders. and after i had helped to build a growing department of surgery at the university of minnesota, i thought i could serve in that role. in particular, i realized over time that my training as a surgeon brought a set of credible things to the table.

one, if surgeons have a measure of emotional intelligence, not much of our training reinforces that, it reinforces skill, not necessarily emotional intelligence. but if a surgeon has self-awareness and emotional intelligence, what they bring to the table of leadership are three fundamental things. number one, they do everything in teams. their operations, the patients they see is all team focused. number two, they value process, but they hold themselves very much accountable to execution. they understand that it's good to explore a patient, but what really matters is that you take the tumor out. number three, they make difficult decisions on incomplete information. those things i realized i could bring to the table as a leader if i had a passion for working with people and have some sense of self awareness. david: he rose up in minnesota, why did you go back to alabama, which had racial issues? dr. vickers: uab is and admit

it's of academic excellence, brought diversity. it's the most diverse carnegie tier one university in the country. it has done more transplanted and african americans in any hospital in the world. i felt a compelling opportunity to continually drive the mission of that institution, in spite of the landscape socially and politically, that i thought it could have a significant impact on the part of the world. david: how long did you run uab? dr. vickers: i was there for almost 10 years. david: when they approached you to do say, i'm a great surgeon, i got when i want here, this is my native state, i don't need to leave. were you intrigued? dr. vickers: it was more the former, like you said. i have a good place, i have a good job, i built a level of trust in the community, i have a compelling mission, and i think i need to really think very hard about leaving it.

i would say there are very few places that would intrigue you to consider it, leaving memorial sloan-kettering is one of them. david: as you rose from a small town only child in alabama to where you are now, you must've encountered a fair amount of racial prejudice. dr. vickers: i had my share of it. i learned early on from one of my mentors at johns hopkins. he was one of the faculty there and he reminded me that people will often have difficulties with you, but don't make their problem your problem. so, one of my early experiences of taking care of a patient who had a liver cancer, or in this case, a bile duct cancer, they struggled that there was a black surgeon saying that they needed half of their liver out. i respected that because it was unusual. even my grandmother had not ever

seen a black doctor, so that was a foreign thing to her. i respected the understanding that what they were going through is not the norm. they called back to johns hopkins to see if i actually trained and i said, do what you need to do to be comfortable with the situation. david: what does it take to be a great surgeon. dr. vickers: this may sound trite, perseverance, resilience, being able to take a blow and not having it become a permanent deformity, and grit. ♪

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david: as the head of memorial sloan-kettering cancer center your biggest problem is getting enough money to do research and give the patients the care they want so they're always raising money or that's not your biggest problem? dr. vickers: it's not my biggest problem but there is a problem. the cost and health care is significant. not only for the patients but for the science and for the drugs. it is a significant part of what i do is putting resources on the

table so that our scientists, clinical's and physicians are able to do their job and make discoveries. david: what memorial sloan-kettering does is it research, than does rick -- does patient care. there is an advantage because you have people doing cutting-edge research. dr. vickers: cutting-edge research that's connected to doctors who are looking to answer questions as well as take care of people. david: you also have students at memorial sloan-kettering. you have a graduate school for students, is that right? dr. vickers: the nursing school is one of the most outstanding in the country. students are focused and our lab largely on basic science in cancer research. we almost have 2000 fellows and residents who rotate the memorial hospital. so we have a robust educational program, although we don't have a distinct medical school, great graduate school, training programs, nearly 100 different

programs. david: what if somebody says they have a cancer that's not a very good kind of cancer, not that any cancer is good, but suppose you have very serious stage for glioblastoma. the advantages you can really make a difference at stage iv for somebody? dr. vickers: the advantage of coming here broadly. the outcomes are different even at stage one for coming. at a stage iv, we certainly have the better chance of often prolonging life and having a chance to getting access to the most novel therapeutics, with no guarantee that we are going to cure you, but we are going to give you every chance there is in the space of cancer to make a difference in your tumor. david: how does somebody become a patient? they walk off of school and say maybe i got a cancer, how do people get to be a patient here? dr. vickers: number one, you can refer yourself and call and we will help make that diagnosis.

or number two, your physician who you've seen as a primary care doctor can refer you here. david: what if somebody says i don't have health insurance, what do you do? dr. vickers: we have services that take care of people who don't have financial ability. david: when you do pancreatic cancer surgery, you are not doing surgery now? dr. vickers: yes, they let me come into the operating room by permission, special occasion. david: if you do it occasionally can you still be up to speed on everything? dr. vickers: i do it regularly enough to know that what i do, the outcomes are not affected. as a low-volume surgeon, you have to watch closely. i typically operate with my other surgeons so i have other senior surgeons that are part of the picture. david: what does it take to be a great surgeon? dr. vickers: this may sound trite, perseverance, resilience, in practical terms, being able to take a blow and having it not become a personal deformity, and grit. the ability to turn lemons into lemonade.

and to not both let discouragement or disappointment from the prior patient prevent you from taking care of the next patient you see. david: you are relatively young by my standard. this is something you expect to do for another decade or so, something like that? dr. vickers: i would say that would be the goal. there are things i want accomplished at memorial. it's a place of phenomenal people and talent. more than ever as we talk about people getting older and the incidence of cancer really growing. i think we have a special role for the society not only in new york and america in the world, and the role that we play around discoveries and in a world of golden age of cancer treatments. david: did your parents live to see this? dr. vickers: my mother did, to a degree. she saw a large part of success as it relates to my family. she lived to see my four kids born. i was an only child so she desired a larger family.

and she saw some of my success as an academic surgeon, particularly for people in her purview who are treated and operated on. i just saw a man two or three weeks ago with my father where i did a pancreatic procedure on 22 years ago who still alive. so my father has seen that as well. clearly, who's 92, has seen her much of my success throughout my journey as an academic surgeon and leader. ♪

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