Ologies with Alie Ward - Hematology (BLOOD) with Brian Durie

Episode Date: January 9, 2018

Bloooood. In this special episode, Alie sits down with Scotsman and hematologist Dr. Brian Durie to talk about blood: what it is, and what can go wrong. As an oncologist, Dr. Durie is a leading researcher in multiple myeloma, a disease that's deeply affected Alie's family. So learn about what's in your blood and how doctors are finding new cures and therapies for the people diagnosed with blood cancers. Also learn about the most scientifically chill way to live your life, what foods to avoid, whether or not Coachella is too crowded and some handy fish slang.Visit myeloma.orgMore episode sources and linksSupport Ologies on Patreon for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramTheme song by Nick Thorburn

Hey, oligites, alleyward here. So blood, it's important. It's kind of scary, and you yourself are a pulsing, barely contained leather sack of it. But what is it? In this episode, we'll talk to a hematologist slash oncologist about what blood does and why he works with it and what can go wrong and how to fix it. And before we dive in, I want to say thank you so much for the 500 review mark we hit

on iTunes. You guys! I appreciate it so, so much. I read every review, like total creep, and it really keeps me going. So I'm going to read you my favorite review this week. Do you want to hear it? Okay. C Magnus said, I'm afraid of death, birds, and the universe, and the episodes about these

topics were so interesting and engaging that I forgot these things terrified me while I listened. Yay! She said, Allie is a great host. Thanks. Who really knows how to keep a podcast flowing in an entertaining way. Very impressed. She records her parts from a closet.

I am in a closet right now recording this. Life. Also, Angelo Z said, I want Allie as a friend. Done. Dunzo. We're pals now. They say, great podcast. I even enjoyed oligies that I thought I was not very interested in.

Can't wait for more. I always love hearing that when someone's like, I didn't think I'd care about this, but it was a good episode. I'm like, yes, we did it. Thank you so much for leaving those reviews. They help so much and they really get the show seen and heard. So this episode, hematology, comes from the Greek for blood, pretty simple, and I learned about this particular oligist through a blood relative, my pop.

So a few months ago, my dad forwarded me an announcement for a charity function in L.A. It was a comedy show with some comics that I'm familiar with, like Kumail Nanjiani and Hannibal Bress, Mark Maron, Ray Romano, and Nikki Glaser, all these people. I was like, whoa, how did they all get involved in this? Well, there is a blood cancer called multiple myeloma and Peter Boyle, who played the dad on Everybody Loves Raymond, battled it for a number of years. And every year, in partnership with the International Myeloma Foundation, his amazing family puts on this comedy benefit to raise money for research.

Now, my dad also has multiple myeloma. So I reached out to IMF to see if they needed, like, some volunteers, and I got involved with the benefit that way and was really lucky to be able to take some time of one of the lead researchers in this field before the event and get him in a conference room and pepper him with questions about what he does. He was so nice. Now, usually I have listener questions from Patreon supporters, but today all the questions are furnished courtesy of Mr. Ward, my dad, who is kicking the ass of this particular

blood cancer. So when my dad was first diagnosed in 2013, I didn't know anything about blood diseases, even though 30,000 people a year will be diagnosed with multiple myeloma and my uncle also had it. Now, when my parents found out, I'm not sure if anyone else who has been affected by any kind of illnesses has done this, but the words multiple myeloma were written on our poster note and given to them by like a nurse to go home and Google. The prognosis at that time was two years and I myself curled up in a ball, honestly, like

hoarsely cried for a few days. Now it's five years later, my dad is still doing well and they have this now faded pink post-it note and it's taped to their computer desk as a reminder of those first really terrifying months and also of a lot of hope. And at this comedy benefit, a lot of the comedians I talked to had to Google the disease, some on the car ride over, they were like, I don't know what it was, which is totally fine. For my family personally, these words are on our minds every day and the people who are getting up and going to work to find cures for this and other diseases are like celebrities.

They're amazing. So here's the deal. When you work at a coffee shop, you probably get good discounts on coffee. With my work, I have access to so many science heroes and getting to sit down and interview someone who's the front lines of this is a pretty big perk of the job. But I struggled with whether or not this episode would be relatable and some of their nitty-gritty about treatments I cut. So if anyone, especially if you've been affected by multiple myeloma wants a copy of the uncut

version, email me at helloallyward at gmail.com. I can also post it on the Patreon page and I'll just give you the full version with all the nitty gritty. I've shaped this episode to be all about what is blood? What's the healthiest, most scientifically chill way to live? What is cancer? How can we make ourselves less vulnerable to cancer? What therapies are being developed?

How many people attend Coachella? What brought theologist to this field? And the etymology of some Cantonese slang involving fish. And I can say I walked away from this interview feeling so hopeful about my dad's prognosis and also more empowered to take care of myself while I can. It's so easy to treat your body like garbage and be like, I'll get healthy later. Or I don't deserve to rest, I gotta hustle. But once you find out how much my dad's chemotherapy costs each month, you will take a nap so hard

and you will only eat spinach and walnut smoothies. Also thisologist has the best Scottish accent ever. So settle in, get your blood pumped to learn all about hematology with Dr. Brian Dury. If you could tell me what is your specific title? Are you an oncologist or are you a myeloma specialist? What do you call yourself? Okay, so I'm a hematologist and I'm an oncologist, I'm both. So I'm qualified and both.

And I'm an internal, I'm an internist, internal medicine specialist. So the site of blood does not freak you out? Well, strangely enough, the site of blood is... So when I got into hematology, specialty of blood diseases, I got interested because it was something that I could study under the microscope. So when you're a learning and you're a scientist and then you can make a slide and then you can look at it under the microscope, I was fascinated because I could see all these different blood cells.

And that was very exciting for me where I could distinguish the different kinds. So that's actually looking at the blood and researching the blood. That's how I became interested in the first place. Did you ever get a microscope when you were a kid as a gift or something or when did it start? This started when I went to medical school. So in medical school, you're studying all kinds of things. But then when we started the part where we were using the microscope, that's where I

got especially fascinated. Did you ever put your own blood under the microscope to see what was going on? Oh, yes, you have to do that as a student. Really? Oh, yes, you check your own blood and then you compare it with all these other different things which you're given for comparison. Wow. So did you ever eat a hamburger and then see what it looked like?

No, I didn't do that. Well, those things are not so obvious on your blood when you're just looking at it. Now, if you do chemical testing, obviously, you could see something, but not just looking at it. And so when did you start studying oncology? Were you a hematologist first and then you started getting interested in blood diseases and cancers? Yes, basically that was it.

So I did hematology training at the Mayo Clinic in Rochester, Minnesota. Heard of it? Good place. Side note, I have some friends who have been treated at the Mayo Clinic and they said it was the best medical care they've ever gotten. Next level. Like Mayo Clinic is like those live flat first class cabin airline seats with the beds and the free wine and the salmon and the cheese when you're used to a middle row seat and

coach next to the toilet sitting near someone with sausage burps. It's just so much better. Okay, now back to the training of one of the world's leading cancer researchers who trained at the Mayo Clinic. So I started off with that and then during my training since I come from Scotland. So I was, I'm an immigrant, I'm a foreign medical graduate. They actually assigned you a mentor or kind of like a coach. And so in that process, my mentor turned out to be a doctor called Dr. Robert Kyle who's

actually very, very famous in the field of multiple myeloma. And so by chance, he turned out to be my mentor and we became good friends because we had both run a Boy Scout troops. Really? He ran the Boy Scout troop in Rochester, Minnesota. And I used to run the Boy Scout troop in my hometown in Scotland. So you guys bonded and then started working together? Yes.

And so his interest was myeloma in more into the blood cancer area. And so I became more interested in that and then ended up doing both blood and cancer. So let's get right into it. Blood is blood. If you are walking around in an adult body, it contains roughly five liters of blood. That's a little over a gallon. Slush, sloshing around, so squishy. So what is it?

What is blood? Well, stem cells in your bone marrow mature and they change into three types of blood cells. Red blood cells, white blood cells, or platelets. So red blood cells carry oxygen around the body. So you need that a bunch. And red blood cells also contain this protein. It's called hemoglobin and it has iron.

And that combines with oxygen to give hemoglobin and our blood the awesome, terrifying red color that it has. Crabs, by the way, have blue blood. And earthworms and leeches have green blood. And there are some invertebrates like starfish that have clear blood. So unless you're one of those, or a plant, or a robot, yours is red. Red blood cells, let's be honest, life of the party. Party would be so dead without them.

Now white blood cells, aka leukocytes, those are cells of the immune system and they protect the body against infectious diseases and invaders. So they're like your friend who talks smack to creeps when they hit on you. And you're like, oh, thank you, I didn't even see them. Finally platelets are also called thrombocytes, it's a cool name. And they're part of the blood, their purpose is to stop bleeding. They do this by clumping and clotting. So when you're like, ugh, come on, let's leave, they're your friend who convinces you

to stay at the party and you're so, so glad they did. If leaving a party was the same as bleeding out to death, which it's not, but I needed an analogy. Okay, so these blood cells float in this salty straw colored liquid called blood plasma. And blood plasma, it's made of about 90% water and it also contains nutrients and electrolytes, gases, proteins, hormones, all kinds of stuff. So you are just this opaque Ziploc full of a complex tomato soup, which is great. But what is blood cancer?

It's not so great. When someone talks about cancer, it's usually preceded by a body part. So someone has throat cancer, liver cancer, you're like, okay, I'm not a surgeon, but I can picture the general area of this cancer because my brain is not made of turnips. But blood cancer is confusing because it's everywhere, but it's nowhere all at once. So you're about to get cocktail party literate on hematology. If you're ever introduced to a hematologist in a dinner party and you are able to impress them, I have done my job.

Okay, here's a quick rundown of blood cancers that may confuse you if you see one of them listed on a flyer for a charity. So I'm going to break it down so that you get the difference. Leukaemia is caused by this really rapid production of messed up white blood cells. They screw up the ability of the bone marrow to make red blood cells and platelets. Leukaemia, white blood cells. Lymphoma is when these other white blood cells called lymphocytes become abnormal. They turn into lymphoma cells.

They multiply and they collect in your lymph nodes. That messes up your immune system as well. Now myeloma is cancer of the plasma cells. So Dr. Dury sums it up. And so the bone marrow is where you make your blood, okay? And so when you have a cancer of the blood, actually it's a cancer of the bone marrow because what has happened is that the bone marrow has been damaged by something. And so then it's not making blood like it should.

And maybe even has turned into a cancer of the bone marrow, okay? Now, in the case of leukemia, that means that you stop making the normal blood cells and make the leukemia cells. In the case of myeloma, it means that you have a problem with the plasma cells, which is a particular kind of a cell in the bone marrow, which is the cell which is part of your immune system. So it's actually a cancer of the immune system. And in your bone marrow, you make the antibodies to fight infection.

Why would your bone marrow do you like that? What happened? And what happens to make the bone marrow turn in blood cancers? Or what happens in general with cancer to suddenly? So what causes it? Yeah. Well, I think that there's been a lot of controversy over the years specifically about myeloma because it seems like more than one kind of toxic exposure can cause myeloma.

Really? So for lung cancer, there's a strong connection to cigarette smoking and the carcinogens, the cancer-causing chemicals, which are in cigarette smoke, okay? So for myeloma, there's been a connection with many different kinds of chemicals. And so as long as like 100 years ago, it was noticed that people who work with benzene, which is a solvent in paints and in factories where they do all kinds of manufacturing with solvents and glues, people who worked with benzene would get myeloma. Really?

Yeah. So there is a linkage, which is called like a proof of principle, where if you're exposed to a cancer-causing chemical, in this case, it can sometimes cause myeloma. Let's lay down a few more basics. So first off, yes, cancer was named after a crab because of the way veins branched off from a tumor, which sounds gross and very moist. Also, cancer doesn't have to be a tumor or a lump that you can like poke with a stick. Cancer just means when abnormal cells divide in an uncontrolled way. So some cells get a little wonky and then they just keep making more wonky cells.

So according to the American Cancer Society, it's caused by changes in the cell's DNA. So that's the genetic blueprint. And some of these changes can be inherited, others can be caused by environmental factors, such as, for example, these things. Ready? I'm going to list these off. There's a long list, but I'm going to read you some that I can pronounce. Alcoholic beverages, benzenes, tanning beds, sawdust, a bunch of chemical compounds I can't pronounce,

the virus that causes mono, diesel exhaust, estrogen therapy, processed meat, aluminum production, tobacco, asbestos, and, quote, salted fish, comma, Chinese style. I saw that last one and was like, damn, that is specific. So what is up with salted fish, comma, Chinese style? Well, turns out Cantonese salted fish is a dish common in southern China,

where fish are gutted and they're hung in a heap of salt to preserve it. Apparently studies since the 1960s have shown that the southern Chinese fishing populations who consume it as a staple are at a higher risk for cancer. This also led me down a hole of Chinese slang surrounding salted fish. And in Cantonese, dead bodies are referred to as salted fish, and a salted fish coming back to life means a person is making a comeback after their career looks belly up. And the phrase, those who eat salted fish must put up with thirst,

is essentially check thyself before thou dost wreck thine self. So there are a lot of things already identified as things that will mess up your DNA. But there are so many environmental factors that we have no idea about yet. Do you think that there's a ton of substances that we are in exposure to that we'll find out later we really shouldn't have been exposing ourselves to? This is so absolutely true. It's one of the very, very big concerns that I have. And so since the industrial and chemical revolution,

since the Second World War, over 100,000 chemicals have been introduced into the environment that we are exposed to, 100,000. And of those, only a handful have been carefully studied and have proper regulations with regard to use and cautions and things like that. OK, one second. I'm just going to bury my face in my arm and groan for like an hour. And so I really do have a deep concern that we will discover many, many cancer-causing chemicals have been out there and we've not been paying attention.

Now, we've learned a little bit about this. So, for example, with the 9-11 event in New York, all these chemicals were released with the fire, with the combustion. And then there was a big development of myeloma in people after the 9-11 event because they were exposed to fire retardants and solvents and all kinds of different chemicals that were suddenly at high levels and really causing a problem. Wow, so we're still having to look at cases and try to find correlations between exposure. That is correct.

So we're at this point of checking, correlating. As a scientist, do you like getting the data and trying to crunch the data? Or are you more interested in kind of the care aspects of being a doctor? How do you approach getting all that data? Quick question, oligites. Do you say data or data? This messes with me every time I say it. And so I usually just say it both ways in a conversation.

That way I am guaranteed to be wrong every time. I looked into it and it seems to be a matter of regional dialect. Although I landed on this web page of a woman named Susan Ryan, she's an American dialect coach who insists that it's data. And for some reason I found her helpful recording very soothing. And then I went down some holes and listened to her say a bunch of other words. Data, data, database, database, data, database. And Susan, according to her bio, is also, quote, a former Alcatraz park ranger, avid bird

watcher, and a lingua file who makes a mean scrambled egg a la Julia Child. I would roll in her posse for sure if she wanted to be friends. Okay. So does Dr. Dury prefer crunching the data or being bedside? Right. So over the years, I've done both types of things, which I would say is quite challenging and became increasingly challenging over the years. And so I've always seen patients in the clinic, you know, I had a myeloma clinic.

So one or two days a week, I would always just see myeloma patients. But in addition to that, for most of my life, I ran a lab where I was studying myeloma and crunching numbers from cell cultures from statistics and all kinds of things like that. So I've done both kinds of things, mostly my whole career. Oh, wow. So you've gotten both of them. Yes. And then what are you working on now?

Tell me like a little bit about gene editing or CRISPR. How does that factor into your work? CRISPR, by the way, is spelled with no E. And at first glance, it looks like an app that disrupts the lettuce industry. But CRISPR is a DNA sequence that stands for Clustered Regularly Interspaced Short Palindromic Repeats. You're fine. You don't have to memorize that.

And CRISPR technology lets geneticists edit parts of the genome. It's crazy and exciting. And Dr. Dury, I feel weird calling him just Brian. So just keep calling him Dr. Dury. I don't know. Anyway, Dr. Dury is working on a bunch of things for something called the Black Swan Research Initiative. The name has a cool, weird origin.

It kind of surprised me. Why is it called Black Swan? Because you're looking for something that is hard to find, and you may not recognize it right away. In the Western world, everybody thought swans were white. And so you have this idea. Swans are white. But then the first ships went to Australia and over by Perth on the West Coast.

And they sailed up the Swanee River. And lo and behold, the swans were black. So they realized that you have to open up your mind and look at things a little differently and say, okay, there are swans. Usually they're white, but actually in Australia, they're black. And in other parts of the world, they're brown and maybe slightly different colors. And so it's a project where you have to open your mind and be open to different strategies to solve your problem.

Are you seeing a lot of scientists and oncologists finding the genes that could make one more susceptible to cancer? Are those getting identified? Absolutely. This is a very, very active area of research. And so through the Black Swan project, we have a couple of groups doing just this so that in Germany, we have a group looking at family myeloma. So they are looking at families where there are two or more individuals within the family

that develop myeloma. And we're collecting a whole series of these families to figure out, well, what is it that's causing this susceptibility? And we're studying them at the genetic level. And what I can tell you already is that there are several types of genetic predispositions. So side note, my uncle Joe also had multiple myeloma, he did not make it, which is another reason why I'd love to interview all of just like Dr. Dury. It's so crazy to me that people are doing this and just walking among us like buying

a phone case at Target. You might never know that this person behind you in line is working on something to save your life or a family member's life. It's nuts. So how long before you can see things like gene editing, like CRISPR being used in the treatment of oncology? How far away is that? It's happening now.

Oh. It's happening now. How? So what you can do is you can edit the immune cells. So you may have heard about a very active type of therapy called immune therapy. And one type is called CAR T cells. And this is a situation where you take the immune cells, the T cells from the patient and then you engineer them and then you give them back.

So CAR T stands for chimeric antigen receptor T cell therapy, CAR T. So if you hear this, the essential deal is that CAR T cell therapy is a way to get immune cells called T cells, which is a type of white blood cell, to fight cancer by changing them in a lab so that they can find and destroy cancer cells. Pretty awesome. So in the gene editing approach, you can really edit and tweak those T cells to really recognize an attack in a very specific way, the cancer that you're interested in. In China, they are already doing this.

They have a trial where they're treating lung cancer using these edited T cells and we're starting to look at doing it in myeloma. It's like science fiction that we're moving so quickly. When you're doing your research, are you splitting your time between chemical therapies and also these genetic therapies that can kind of prevent or treat it? Yes. So the way that this kind of slots into the day to day activity is that most patients, when they start out, we have these therapies that we know can work well.

But then we know that those will produce remissions for a few years, but then when that impact is starting to wear off, then they need new therapies. And so this is the perfect situation and opportunity to say, okay, what are the new therapies that can rescue and treat at this point? And then from those, like the core T cells look very promising. And so we're thinking, my God, they're really rescuing pretty well in the relapse situation. Maybe we should be using them even earlier. And so are we five or 10 years off from this happening in the US, do you think?

No, it's happening. This is a very rapidly changing field. So core T cells have been approved, not using the CRISPR, but just in general, they've been approved for leukemia and lymphoma in the US. And so this has been described as like a new space race, Sputnik 2, where the Chinese are working on it and the US are working on it. It's really like competitive. Are y'all friends or is it a little bit like, oh, what are you working on?

Is it like watching cooks on a cooking competition? There's quite a bit of that. They're all cooking up their own brew, you know, and you know, there's a little bit of competition that what you're cooking could be the best, you know, and it's good. I welcome this competition. I'm like, whatever gets you guys working fastest, I'm into it. My dad had some questions he wanted me to ask you. He's as a patient and also as a former journalist who loves to research things.

He's on it. He's on all the blogs. He wanted to know, he wants to know why cancer drugs are so expensive, how much of the cost is research related and how much is like related to protection against lawsuits. Okay. Once again, the listener questions, they're all from my dad this week because this is a special ep of oligies and this question is about the cost of pharmaceuticals. His chemotherapy comes in a pill form.

He takes every day at 4 p.m. and it's called Revlimid. It's saving his life and it's thankfully covered by a program called Veterans Choice. And the retail price, if it weren't covered, would be over $16,000 per month. Why does it cost so much? Right. So this is really, it's a lot of reasons why. The main reason that's put forward why, certainly on behalf of the pharma companies, is that they have development costs.

You know, they're testing this drug, testing that drug, and then they've got to do all these trials, which are very expensive, cost millions of dollars to test and make sure it's safe and things like that. This drug did cost several million dollars to research and develop, but it's made $20 billion for its parent company since its release in 2004 and the price keeps going up. Now, on the other side, it's hard not to be grateful that people are even working on this. Also, the makers are being sued, class action lawsuit, because they failed to share some

information that would help get a cheaper generic out there. Come on, guys. Then ultimately, there is this question that, for example, Revlimid has been on the market for quite a number of years now. And so you would say, well, absolutely, there were development costs, but this is 10 years later, 15 years later, so maybe this would be the time to have a more reasonable cost. And so this is something that is really prominent at the political level right now. There are reasonable drug costs.

And so that has become a complicated process where the companies, they extend their patents. And then even the generic folks, when they come in, they don't reduce the costs so much. So everybody's in it to make a buck. And so this is, in my opinion, very tragic and difficult because this is not like selling cars or watches where you say, well, this is a beautiful watch. You could have a markup. That's fine. But this is drugs that are to save people's lives.

And so I'm not so happy about markups in that environment. If you want to know why watches can be so expensive, by the way, and you deeply enjoy some Jay-Z watch puns, listen to the horology episode of ologies. Just get it. Just say it. What you could buy for $16,000 a month instead of 28 pills or 30 pills. Right. Oh, my gosh.

I know. And so you see, in other areas, it's been easier to work around it. So for example, in the area of surgery, so people say, well, you know, I could get my knee replaced in Nevada, or maybe I could fly to Thailand and get it replaced. And it would be half the price, even including the cost of the flight. It's so crazy. It's so crazy. I know.

We joke that my dad's $500 pills are like Kim Kardashian level. If you spent that amount of money on like champagne and caviar, you'd be rolling. Exactly. Instead of taking that $1,500 pill a day that's saving his life, my dad could be every day getting bottle service, which starts at around $400 at L.A.'s douchey as nightclubs. Or he could be buying every day one pair of Yeezy Clear PVC Siletto pumps. Dad, a PVC pump isn't a plumbing thing. It's like a clear plastic high heel designed by Kanye West.

And so I think I do see that this has to be addressed. It is unsustainable. So do oncologists collab? Do they work together? Do they play nice? I would have to say, though, that outside of the U.S., we've been really, really excited and had the opportunity to work with some great teams, you know, outside of the U.S. who are doing amazing things.

One of the coolest projects that we're doing is in Iceland. What? So we're studying everybody in Iceland. Everyone? Everyone. How many people are in Iceland? 340,000. That's it?

Yes. Oh, gosh. That's like Studio City in L.A. That's like Los Feliz or something. Right. Okay. I was way off. The population of the L.A. Suburb Studio City is 37,000. Los Feliz, just about the same.

So I was wrong. But 340,000 is less than the population of Staten Island. And it's about equal to the total attendance of one Coachella weekend, which is a very bone-chilling statistic. Coachella is so crowded, you guys. But it's a whole country, and so there are so many opportunities where you could test and then offer therapies to a whole country where you're not excluding anyone. So they're all part of the same electronic medical record system.

Oh, wow. You know what's happening to everyone from the time they're born all the way through until they're getting diseases and having issues. So the other thing that happened is that there's a big genetic company in Iceland called Decode Genetics that actually did DNA sequencing of all the people. Everyone. Yes. Wow.

Mind-boggling. In real money, it would have cost billions of dollars, but they did it in a different way where it didn't cost them quite so much. And so this is incredibly powerful, incredibly powerful. And so we will learn what are called the driving mutations, the ones that are leading us forward. And this will be a huge opportunity for CRISPR. So once we say, oh my God, this is the gene, well, we would be able to edit it and prevent and to treat.

So it's going to lead in to all these new molecular opportunities. Thanks, Iceland. I asked if eating walnuts helps because we read that eating walnuts helps. And you guys, my daddy's walnuts every day. Maybe walnuts are magic. Maybe walnuts are the brains of aliens from another dimension and they fix everything. Maybe they just have a lot of antioxidants. But you do need to have your body and your immune system in the best shape to accept

all these kinds of therapies. Right. It's clear that having your best diet, your best vitamin combination is absolutely helpful. But you shouldn't have too high of an expectation. Walnuts are not a reliable cure, but this next part rules, totally blew my mind. And so I've been most interested to study places where people live to be over a hundred, where they're apparently pretty healthy. And the question is, what are they eating?

Yeah, exactly. Probably not as much jack-in-the-box as we do, but... That is the summary. That is the exact summary. So the first place, they're called Blue Zones. And the first one is a Greek island close to Turkey called Ikaria. And so they have Mediterranean diet, as you might expect. And so they have also very low stress.

They have no clocks on the island. So they're not concerned about time. Are you kidding me? So they have low stress. They have no clocks, no mortgage. See, these are families that have lived there for hundreds of years. And so they're just living there. And they have, you know, chickens, they can go fishing the ocean, and they can grow some

grapes, have some nice red wine, and they have a Mediterranean diet. And so this combination seems to be rather healthy. But there is no jack-in-the-box, you know, and they don't eat junk food. They don't eat diet. They don't have diet drinks. You know, they do drink wine. They do drink teas. They put honey in as a sweetener.

So they do a lot of, like, healthy things. And so it is possible to come up with, like, a healthy diet. So all you have to do is move to an island utopia, and you're fine. Now if you're not into Greek isles, some of the other blue zones are Okinawa, Japan, Ireland, Sardinia, Italy, Ireland, Nikoia in Costa Rica, which is a peninsula. I'm going to blow your mind right now, but peninsula comes from Peine in Sula, which means almost an island, case in point. And finally, okay, what's the last island you think it's going to be?

Melinda, California, which is not an island. It's this weird outskirt suburb of Los Angeles. There's a group of seven-day adventists that live a life so chill that this one little area counts as a blue zone. Very shocking. So some commonalities that lead to these long, relatively disease-free lives are family, putting it ahead of other concerns. Less smoking, semi-vegetarianism, the majority of food consumed, derived from plants, moderate

physical activity, social engagement, and finally, beans, commonly consumed are legumes. So it's part diet, part behavior. And also a healthy pattern of behavior, which is to, we can't ignore the time, but we can certainly try to reduce that time stress factor. Right. I am doing everything the opposite of everything you just described. And also, scare me out of diet drinks. We shouldn't be drinking diet drinks, right?

You should not. Okay. Good to know. What are they? How do they kill us? Then things like coke, they do have that brown color of the coke. That caramel is not so healthy, in fact. So the dyes are not so healthy.

And then the things like aspartame, the sweeteners, those are not good either. I just started down a rabbit hole about diet sodas and the links to various diseases and increased weight gain and a higher incidence of depression. And man, go research it if you want to be scared off. I have to do another episode just all about that. It reminds me of the days when our parents' generation smoked indoors and on airplanes and in neonatal ICUs and in offices. And they were like, yeah, everyone knew it was bad, but this is what people did.

And now we find it horrifying. There's a number of different things about those drinks that can be negative. So juices, water, wine, teas, those are all good. But diet drinks, no. Okay. Good to know. That cements my position on that. I may have had one yesterday, guiltfully, and been like, what am I doing to myself?

So what are, in terms of other, or actually, this is a personal question, but being a doctor and a hematologist and oncologist, how often do you notice symptoms in yourself like back pain or does my shoulder hurt or do I have this or are you pretty much not a hypochondriac because you know so much about medicine? Because I feel like the rest of the population walks around every day being like, do I have cancer as an oncologist? Do you think about that? Yeah, I do.

I think that I'm not a hypochondriac. And I think it does help to understand that we all might tweak our back one day. You get up the wrong way or you're on or you walk the wrong way, but that's not cancer. And it'll be gone in a few days. So you don't need to rush to get scans and blood tests and things that you'll get over it. And so I think there's a tendency to think that if you come down with a really bad cold or something that it's going to be the start of something really bad.

Now we don't want to ignore those things, but certainly individually, maybe less immediately worried. Right. So you at least know what to look for? Yes. Okay. That's good. So okay, doctors aren't usually paranoid hypochondriacs.

I will say there is a hugely studied reluctance, particularly in men to go to the doctor when they feel a little off. Men also have shorter life expectancy. So if you're feeling off and you can't catch your breath, your bones hurt, your vision gets weird, whatever your symptoms for whatever, go to a doctor. My dad ignored feeling awful for months and my mom finally forced him to go. And by that point, they just legit admitted him to the hospital for blood transfusions. She saved his life.

Way to go Nancy. So dudes, go to doctors. Dad, go to the doctor next time mom tells you to. Do you have a lot of people in your family that call you or text you and say, Dr. Dury, let's go ahead. Well, yes, quite a few, although I would say that within my family and friends, they're not so hypochondriac. That's good.

Maybe it's a Scottish thing. It's a Scottish thing. Yes. Yes. So my mother lived to be close to a hundred and my sister's pretty old. So we're not like, we're fortunate. We're not an unhealthy group of people. You probably stayed away from Diet Coke and hamburgers.

Now last couple of questions, last two questions. What is something that is the part of your job, part of your work that is the most challenging that is maybe the thing that's the more of a slog or something that is difficult. And then I'll ask you what your favorite thing is. What is something, anything from parking to. Yeah. Well, I think that the saddest and the most difficult thing has been the way that medicine has changed over the years that I've been practicing medicine is where, you know, I,

for many years, practice, practiced it on an individual basis where I would have my patients, you know, and I would take care of them. If they went to the hospital, I would see them. And then when they came out, I would take care of them. But now medicine's become a business, you know, I take care of them, you know, I'm not there on a Saturday, somebody else takes care of them, they end up in the hospital and then this happens and that happens. And then it's a whole bureaucratic nightmare where the individuality of the patient care

has really lost that personal possibility. The paperwork is enormous. And then there are so many challenges when you see your patient. I would say that the biggest one is something that we touched on already is, you know, I want to give this cocktail, this medicine, will my patient be able to get it and to afford it? And this is just so difficult. And as I travel around the world, obviously there are issues here in the U.S. But outside of the U.S.?

So once again, as much as the price of some therapies are infuriating, we are lucky to have them. I mean, there are whole countries that don't have Revelement. I mean, so that means that they don't have access to anything beyond therapies that we had in the year 2000. And so this is a really a sad and difficult thing for me to see that there are so many patients that don't have the treatment that they deserve and that they need. I imagine also, the work that you do, you have such an interest in seeing how each of

these patients does, getting to follow through is probably pretty gratifying. Right, right. So now, you know, I have patients that I see 20 years later. Ah, that's great. Tried really hard not to cry at this point in the interview. Which is fantastic, you know, and, you know, they'll remind me that when I first met them, I said that my expectation was three or four years. Wow.

And then, you know, I had a patient recently, she and her husband, they reminded me that I'd said that, but it was 20 years now. That's great. I love it when doctors are wrong in that fashion. That must be the best. That's the best, okay. And so what is your favorite thing about hematology or blood or what you do? Like, what is the thing that just really kind of gets you excited about starting your week?

Well, I think the most exciting thing is that we are starting to make so much progress, that we have these new drugs, that patients are living longer. And so that when I see a new patient now, it's kind of not like, oh my God, you know, it's going to be two, three, four years, you know. Now I can say, well, we're expecting you to live at least seven to 10 years. And during those seven to 10 years, we'll probably have something even better. That's great. You know, so it's really more of a joy.

It's still a lot of hard work, but it's a much more positive situation than it was before. Try not to cry while editing this, but still crying a little bit. That's great. That's got to be, that has to give you so much motivation for doing your best on the job. Exactly. Exactly. Well, this has been so informative. Thank you so much for sitting down with me.

I can't believe it all started with blood under a microscope. Well, thank you for your very insightful questions, which very, very good to have a chance to talk to you about these things. Of course. Some of them come directly from Larry Ward in the mountains. All right. Well, tell Larry Ward that I am very happy to give these answers and many more as the questions pop in his head.

Okay. Oh, good. Thank you so much, doctor. This was great. So in summary, let's all move to tiny islands and live to be a hundred, or at least stop eating garbage and go to the doctor when we're sick. So I want to say a huge thanks to the Peter Boyle family and Lorraine Boyle for their work in raising millions of dollars to find a cure for multiple myeloma.

And to Peter Anton and Randy Lovett and everyone at the International Myeloma Foundation for access to Dr. Dury. Thank you to him. More info is at myeloma.org. Also, side note, my mom has MS. So if there's a neurologist out there, holler at my face. Thanks to Stephen Ray Morris for editing this down to the wire because I'm so behind after getting stuck in the Northeast bomb cyclone storm this past week.

I'm so behind he's editing this like hours before it goes up. Thank you, Stephen. I owe you a million dinners. Thanks to Hannah and Erin for running the oligies Facebook group, which you can totally join. Thank you for being great friends also. All kinds of oligies merch is available at oligiesmerch.com. There's t-shirts and hats and pins and the sales help make this podcast possible. So thank you, Shannon Feltas and Bonnie Dutch for that.

They do awesome design work and I heart them. If you like the podcast and you want to support it, you can become a patron for as little as 25 cents an episode at patreon.com slash oligies. You may notice I do this ad free. So this helps me pay the cost of production. You can also help so much for zero dollars just by signal boosting. You can rate and review on iTunes. That helps so much.

So does Instagramming, tweeting about the podcast, telling a friend, oligies is at oligies on Twitter and Instagram. I'm Ali Ward on both. And for your end of the episode secret. Um, okay, um, oh no. Okay, once I didn't want to pick up a phone when somebody called me. So I didn't answer. But while it was ringing, I fully clothed, got in the shower,

walked into my shower without the water on, stood there for just a few seconds while the phone rang and then I stepped out so that I could technically say later, I'm so sorry I was in the shower when you called and not be lying, which is insane. It would be better just to lie or say that I didn't feel like talking to you, but lying seems so evil. So I don't know. I don't know. I'm working it out.

So that's your end of the show secret. Okay, that's it for this week. Thank you so much for listening. I like you so much. Very honestly, go ask smart people dumb questions because curiosity is never not cool. Okay. Bye-bye.