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. and then i started interviewing. i watch her interview so i know how to do interviews. i've learned from doing my interviews out leaders make it to the top. jeff: i asked how much he wanted, he said 250, i did not negotiate or do due diligence. david: i have something at like to sell. and how they stay there. you don't feel inadequate being only the second wealthiest man in the world, is that right? one of everyone's greatest fears is that here she might be diagnosed at some point in their life with cancer. i had a chance to talk with dr. vickers who works at one of the leading cancer centers in the united states and i talked to him about the progress being made in treating cancer. so, today, we are more than 50 years after president nixon

declared war on cancer. have we really made that much progress in the 50 years or so since he first declared war on cancer? dr. vickers: i think we have. the ability for someone who has a diagnosis of cancer broadly thinking about having a chance of a cure has significantly improved. we have gotten them from all cancer diagnosis probably around the time of that announcement, that was around 30% to 40% chance of cure. they were approaching 68% to 70% of patients across the board to 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 the question everybody asks, but what is the answer? dr. vickers: the best way to avoid it is obviously healthy lifestyles, avoid smoking, certainly limit red meat to the amount that you eat all these are no guarantee you won't get

cancer, but we know they probably have a role in accelerating or increasing risk. in general, there is no actual way to prevent it. there are certainly things we can do to screen early and if we catch cancers early, we have a really good chance of curing it. david: what what extent is behavioral factors and what extent is genetic factors that causes cancer? dr. vickers: it's a combination. a small percentage of inherited genes that put you at risk. the most common is brca1 and two for women with breast cancer, increasing risk for ovarian breast cancer in one or two others. those we know and can detect, there are others genes that are passed on that significantly increase your risk, but that's a small number. the other genetic aspects are genetic mutations that occur over time because of the environment and age. those mutations, sometimes caused by viruses, caused by cells that are not correcting themselves, certainly have a

role in actually producing malignant cells that grow out of control. there is environmental exposures. we are learning more. we know that there are multiple chemicals that do it. but it's the broad combination. i would say the biggest contributor is our aging that has a big factor. david: what is the most common cancer that humans get, 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. three hundred thousand cases of breast, somewhere around 280,000 cases of prostate. lung is arguably one of the most, if not, the number one killer. about 150 1000 cases but it is the most lethal, large number. pancreas cancer, the incidents have increased. when i begin my practice there was 30,000 cases a year.

on average zero over 65,000 new cases of pancreatic cancer a year. so, 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 in 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 kinds of things for brain cancer or for pancreatic cancer. dr. vickers: we doubt. there are clearly tests that are being evolved based on being able to detect circulating tumor dna and other markers. in our ability to have broader ability to manage the data through complication 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, we have 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 about them until may be stage four. glioblastoma's, brain cancers, pancreatic cancer, may be liver cancer. dr. vickers: that's right. david: 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? dr. vickers: so 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 cat scanners to screen. we need a better ability to enrich who's truly at risk. recent studies now with ai have begin to predict who in the

population by virtue of a number of things that they have pulled together, medical history, some blood tests, who's at risk for pancreatic cancer. we do know now if you are a smoker, a certain age, are exposed to smoke and you are over 50, you should get a low dose c.t. scan which is proven , to have a significant difference in outcome and detect early cancers. yet, only about 6% to 8% of eligible people take advantage of that cat scan. one, i think it's coming, david, that ai programs looking at data can enrich the population who we know may be at risk. and then, once doing that probably getting a scan, mri or , ct scan is probably going to be the tool, which we can't do for everybody but you could do for a select population. david: pancreatic cancer is the disease ruth bader ginsburg died from. increasingly, many people have

it. 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. number one, 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 and make a difference. 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 -- skills could resolve. 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 of 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, one, if there is a sudden weight loss. david: i've noticed that. dr. vickers: 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 -- dark or i began to have some

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. i know it's not directly in your area, but 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, at this stage, 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 time. 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 i assume, so 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: no, they had no clue what i might be. i think they simply wanted me to be the best i could 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 grandparents -- great grandparents who 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 would say this, i grew up in a

town called huntsville and 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 you got into johns hopkins 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 -- playing ground took a year for it to occur. once the playing ground became level i found that i could could -- i could compete just 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. but challenged johns hopkins that it clearly needed to be more diverse. he wrote all of the african-american applicants in the country and encouraged 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, looked around the country and 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 at hopkins, 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: as a great surgeon sometimes you might say i don't need to go into administrative parts of hospitals, i just want to be a doctor and just do surgeries. what prompted you out of doing surgery to be an administrator at a hospital and a 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. 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: so you rose up in minnesota, why did you go back to alabama, which had racial issues? dr. vickers: uab is a unique

place. it's of academic excellence, broad diversity. it's the most diverse carnegie tier one university in the country. it has done more transplanted in african-americans than any other 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 nine and a half years, almost 10 years. david: so when memorial sloan-kettering approached you, did you 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, in practical terms, being able to take a blow and not having it become a permanent deformity, and grit. ♪ when you automate sales tax with avalara, you don't have to worry about things like changing tax rates

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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. there is no doubt 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,

our clinical trial lists and our physicians are able to do their job and make discoveries. david: what memorial sloan-kettering does is it research, then it also does patient care. there is an advantage because you have people doing cutting-edge research. dr. vickers: yes. 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: yeah, the -- school is one of the most outstanding biomedical schools 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 fellowships at memorial.

david: suppose somebody has a cancer that's not a very good kind of cancer, not that any cancer is good, let's say you have a very stage -- very serious stage for glioblastoma, the advantage of coming here is that you can 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? somebody walks off the street and says, i don't feel well, i think i have 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.

either way. david: suppose somebody says, i don't have any 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: i still do some surgery. yes, they let me come into the operating room by permission, special occasion. david: if you do it occasionally can you still do surgery and 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 as well. david: what does it take to be a great surgeon? dr. vickers: this may sound trite, perseverance, resilience, and -- 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 to see 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, in america, and 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 your success? obviously you are very successful person 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 cancer procedure on a man 22 years ago who is still alive. so my father has seen that as well. clearly, who's 92, has seen her -- seen much of my success throughout my journey as an academic surgeon and leader. ♪

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>> u.s. president joe biden has a problem. >> what's top of mind for you right now? >>