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Supper Club with Joe Fresta
Dr. Gautum Agarwal Director Of Precision Medicine At Mercy
The Supper Club brought to you by Mercy, transforming the health of our communities. Kuna Food Service, a family-owned tradition since 1918. Lordo's Diamonds, your family jeweler for life. Oliva on the Hill. Ackerman Toyota, the number one St. Louis Toyota dealer in volume sales back-to-back years 2023 and 2024. Thank you, St. Louis. And Fresta Limoncello. Keep sipping, my friends. Welcome to another episode of The Supper Club. I'm Joe Fresta, sponsored by Mercy and Kuna Food Service. Today we have a very special guest in the field of cancer with Mercy, Dr. Gautam. Agarwal. Doctor, welcome to the show. Glad to have you. This is something near and dear to my heart because I myself have been a patient at Mercy Cancer Center, the Pratt Cancer Center, since I was 25 years old, being a two-time cancer survivor, once when I was 25 and again when I was 38. So I was really looking forward to having you on and talking about all the latest and greatest things going on in the world of cancer and some other things that we're gonna talk about. And again, welcome to the show and just introduce yourself. Tell us a little bit about how you got with Mercy and then how your career progressed to where it is today. I
SPEAKER_03:appreciate it, Juan. Thanks for having me on. Absolutely. I feel really honored and privileged to be able to talk about this with you and also the whole audience because it's something I've dedicated my life to so far. And so being able to share with more people will hopefully affect more lives. And so thanks again for having us. Again, my name is Gautam Agarwal, and I do primarily urologic oncology. So I practice medicine in people who are afflicted with different cancers of the genitourinary system. So things like kidney cancer, people who have prostate cancer, testicular cancer, adrenal cancers, penile cancers, and bladder cancers. And other kind of rare things that do come up with that. And so I do surgery for those things. And then most recently, the last few years, I've been able to lead our efforts at Mercy with what's called precision medicine, where we're utilizing kind of artificial intelligence combined with kind of the latest and greatest that we've been able to achieve with science in terms of sequencing people's DNA. Right. And so the combination of that... They call it
SPEAKER_02:genomes? Yeah, to sequence somebody's genome.
SPEAKER_03:And so what's really cool is... being able to combine kind of my surgical practice and seeing patients and doing surgery and then taking kind of those new technologies and seeing it really have an impact on people's lives. So I feel fortunate to be able to be kind of where we're at right now and uh right to answer your first question i'm from st louis i know and so that's why you know my first job here out of fellowship was to come to mercy and i've i've been here since i haven't left that's all it's always been a mercy you did your undergrad at duke university and
SPEAKER_02:then you did your you went to med school at st louis university
SPEAKER_03:you are correct yeah i did my undergraduate in uh actually engineering so i did biomedical and electrical engineering and then uh i really got uh excited by the aspect of some of the instant gratification that comes with taking care of a patient in surgery. Sure. And so that instant kind of like you did something and it affected their life in a positive way. And so that kind of led me out of engineering and more into medicine. And then at St. Louis University, I pursued more study in that.
SPEAKER_02:Sure. So tell me a little bit more about how did you choose urology? How did you pick that path? Because I myself, I just mentioned cancer survivor. I'm a two-time testicular cancer survivor. or survivors. But how did, what made you go into that particular field
SPEAKER_03:initially? Well, one, I would say, you know, congrats on your journey and how successful it's been. And obviously you look in excellent health.
SPEAKER_02:So that's great. Thank you. Well, Mercy was a big part of it. I mean, you know, they're
SPEAKER_03:a big reason why I'm still here. So,
SPEAKER_01:yeah. And
SPEAKER_03:so, you know, urology is interesting. It's one of those things where it's not like when I was like eight years old, I was like, I want to be a urologist. Nobody really knows about that at that time. But what happened is I think most people pick their path in life based upon the people around them and their mentors. And so when I was in medical school, I happened to be around a lot of amazing mentors. And those mentors were people I wanted to emulate. And so when I saw that, I was like, well, I could do gynecology, I could do neurosurgery, orthopedics, a lot of options, ophthalmology, general surgery. and what i saw was that you know they're all very cool fields and interesting and you can help people but the urologists all seemed like really happy people you know and the mentors were just nice people and they seem to have uh an aura about them i was like i want to be like really yeah and so when i saw if you look at it actually nationally most of the leaders of Most medical systems across the nation were urologists, interestingly. It's a highly selective field, so I think they just kind of self-select people who are kind of like, you know do really well in terms of like scoring and testing but also they I don't know just the people who go into your audience seem to be nicer happier people and so I chose that field went into it and then within that had even greater mentorship amongst people at Loma Linda which is a medical center in Southern California and man the people there I encountered were just salt of the earth people and the physicians that I encountered they're truly amazing taught me how to not just learn the skills of surgery, but to be a good person. And so one of my greatest mentors there, Dr. Ruckel, was an oncology surgeon. And so I was like, I wanna be like him. And so it's interesting, you end up wanting to be like people, not necessarily, it's not like a thing that you just end up becoming, you emulate others that are around you that are great.
SPEAKER_02:Yeah, I was gonna ask you, there had to be somebody who you met you know in your journey maybe you hadn't picked a a specialization yet exactly and you were like you just were really drawn to this person yeah and you're like that's what i want to do i want to do what he does
SPEAKER_03:exactly i had uh in in medical school i'd say it's dr paula gary you know he's a pediatric urologist sure and i actually get to work with him still because he's a pediatric urologist at mercy it's kind of oh really yeah so it's actually he's like not only a mentor but he's also like my good friend the colleague and a friend yeah and so and then uh in resident it was Dr. Ruckel, and then in fellowship, it was a really brilliant surgeon named Dr. Sexton, and he always had utmost ethics, utmost integrity, and so he really taught a lot about the integrity aspect of medicine, and so I try to emulate him.
SPEAKER_02:Yeah, and that's something. One of the things, and I've been involved with Mercy, with the Foundation Board and things of that nature through my cancer foundation, and it just seems to be a common theme with no matter who you meet within the Mercy system, whether it's people in admin or nurses that I know, just people that are friends of mine that are nurses, not specifically at the cancer center, I've met, and then there's doctors and whatnot. You just all seem to have that common theme that you just want to help people. You're good people yourselves, and so I'm sure that environment is very sort of addictive in a way, and you just want to be part of that whole effort, that
SPEAKER_03:engine. Yeah, I agree. I think you nailed it. One thing that's special about being in the field of medicine, when you have to care for somebody
SPEAKER_01:that's ill,
SPEAKER_03:no matter what environment it's in, whether it's on a mission trip, whether it's in the city, whether it's in the country, whether it's at a big hospital or a small clinic,
SPEAKER_02:when
SPEAKER_03:you have to care for somebody who's coming to you that's ill, there's an immediate kind of empathy that forms. And you said it kind of well, you do get kind of addicted to that feeling of helping. And so I think that we're kind of lucky in medicine where every day you get to go to work and one it's very different you know today i had a robotic surgery on somebody and um you have to remove part of their kidney and tomorrow we have to do something different you know remove somebody's bladder or see somebody in clinic that's getting afflicted with other problems And so every day is very different. Every day requires an immense coordination of efforts. So it's my effort combined with the anesthesiologist, combined with the nurses, combined with the medical assistant. It requires the janitors and the cleaning staff, the cafeteria. So that immense coordination of efforts. If you like teams, there's no better place to work than teamwork and medicine. And so you have this newness every day. immense amount of coordinated teamwork, and then you have a patient that you're trying to help and have empathy for, and then you can see the outcome. And so it is correct that you're gonna have this constant feeling, whereas in some other fields that I looked at, because I was an engineering major, it just is harder to find that.
SPEAKER_01:You can find it,
SPEAKER_03:for sure. And you probably found it through many of the foundations that you've
SPEAKER_02:worked with.
SPEAKER_03:You can find that feeling somewhere. In medicine, I just think it's easier to find. And there's nothing
SPEAKER_02:like it. There's nothing like it. When I help a family out, who's stricken with cancer, whether it's mom, dad, the child. And you can help that person. And my directive is basically to take care of some things so they can just focus on getting better. And when they do, it's just a great feeling. It's a great feeling. Just like you. You have patients, and you see them. And I'm sure there's the ups and downs, too. Exactly. Some people don't do as well. Right, but then there's the ones that do, and maybe you thought maybe they weren't, and then they do. It's just so much more gratifying. But I think it all started with the Sisters of Mercy, right? And many years ago, they started this from the ground up, and it just sort of roots, and then the branches go, and everybody just becomes part of that, even though it was a long, long time ago that they started this. You're exactly right. Yeah, amazing. You were talking about... robotic surgery. If I'm looking down in a surgery room, what exactly am I seeing? when a surgery is being performed by robotics.
SPEAKER_03:That's also one of the cool things when I was engineering major and kind of looking at surgical fields. Urology was one of the first to embrace robotics. One of the first robotic surgeries in the world was performed in around the 1990s, late 90s. And Mercy actually was at the forefront and we adopted it around 2006 or so. And we actually have an excellent robotic surgeon for prostatectomies Dr. Anglo, who's done the most robotic prostatectomies in the St. Louis area, at least. And we have now a huge department of urology where many of the doctors perform robotic surgery, in addition to myself, obviously. And I do robotic surgery for kidneys, for prostates, and various other things. But those are the two main things for people with those types of tumors. Take the prostate, for
SPEAKER_02:instance. That's such a big thing with men today. They say... if you live long enough, just about every man will get prostate cancer. But talk about how that robotics, how do you target the prostate? How does it perform and how does it accomplish what you
SPEAKER_03:want it to accomplish? So basically the robotic surgery platform is essentially a tool. I always tell patients, I say, We have a knife, scissors, all sorts of things that we do regular surgery with. And I do a lot of traditional open surgery where we make a large incision for other types of tumors. What the robotic surgery allows you to do is we have these tiny incisions that we make. And if you've ever heard of laparoscopic surgery, it's kind of an iteration of that. So we have these small incisions. And before, we had to put instruments and we had to control it with our arms. It was ergonomically not great. And honestly, the precision you get from controlling it with your own arms was just not perfect. It was hard to teach. It's still about dexterity and feel. Yeah, and so you need to have that. Coordination. With laparoscopic surgery, you lost some of that. Now with robotic surgery, which the main platform is something called intuitive health. The robot is actually called a da Vinci. Okay. And so they actually named the robot DaVinci. I've heard of that. And so the DaVinci robot basically is a tool that attaches to those instruments that you put in. It has scissors. It has a camera. And the camera can zoom in like 10x. So better than your own eyes, you're seeing way up close. So it's almost like cell layer by cell layer you can cut. And then the scissors, what's amazing about it is when I move my hand like this in a separate console. So you're not actually, I'm not controlling the robot directly anymore. So now I'm sitting like, I could be sitting in this building right here. We haven't set it up like that yet. If you have good internet access, you will be able to. You could. Where they have some telehealth surgeries going on globally. So you have a surgeon who's famous in St. Louis who does a lot of this, can park the robot somewhere in China or something, and they're controlling the robot in China. You better have good Wi-Fi. But at Mercy, basically, it's in the same room, obviously, with wires. So there's no risk of any problems. And every movement I make... Yeah. If I go like this, it moves precisely
SPEAKER_02:like that. It's precise. If I go like
SPEAKER_03:this,
SPEAKER_02:it moves precisely like that. Is the da Vinci in the new portion of the cancer center south? on the southern side of Pratt?
SPEAKER_03:So it's not actually in the Pratt Center. That's not there? Okay, that's something else. So that's the proton radiation center. Okay, all right. Yeah, the radiation center is another cool top we can talk about. Okay, my bad.
SPEAKER_02:No,
SPEAKER_03:but
SPEAKER_02:it's also very cool. When I go have my appointment every six months, I see it. Yeah,
SPEAKER_03:no, actually the proton therapy is an amazing new tool. Okay. But we have four DaVinci robots, and we're the first to have actually the newest version called the DV5 in St. Louis. We're the first to have that robot. Wow. And they're all housed in the main hospital in St. Louis. We do gynecologic oncology surgery, so we remove a lot of uterine cancers that way. Colon cancers are removed that way. Lung cancers are removed that way. Kidney cancers, prostate cancers. We do a lot of reconstructive surgeries using the robot. We do hernia surgeries using the robot. Even some occasional ear, nose, and throat surgeries, interestingly. And what I would say for me it's allowed is smaller incisions, better dexterity, better ability to do surgery in a more bloodless way so you lose much less blood usually I think people are able to leave the hospital much sooner get back to normal life sooner and I think you do get a little bit lower rate once you've done enough of kind of side effects like impotence and leak kind of incontinence that comes with sometimes surgery in addition to sometimes I do believe you can see kind of where the margin of the tumor may be in certain situations better with a robotic platform. And it's only gonna get better, honestly. The technology we're adding to the robot over the next decade is gonna be so amazing that I think it's gonna improve the lives of patients even better than it already has.
SPEAKER_02:When you do it, when you're actually performing it, are your hands on a mouse is it are they no so it's actually like a joystick no yeah we're seeing the
SPEAKER_03:monitors right here and you put it in your kind of faces in it oh and then you have foot pedals that control the energy that you use to cauterize oh my gosh and then you have amazing three fingers in each like kind of like a glove almost okay and your two fingers and the thumb two fingers and a thumb and then you kind of it looks kind of like this when you're doing the robot and then i have an assistant at the bedside you know where the patient exactly like just a few feet away that's helping do other stuff right here so it actually is a fascinating thing and if you if you are curious about it you can honestly youtube it and you can see actually some robotic surgeries that have been uploaded with patient, obviously, consent, not from Mercy, but general videos across
SPEAKER_02:the world of the DaVinci robot. I do remember maybe seeing videos of the old way when the guys were... Oh, the old
SPEAKER_03:laparoscopist, yeah. I would say that was very difficult. Which I thought was, back in the day, it was pretty cool. That was very cool, too, but it was very difficult. Yeah, yeah. I think that, yeah, the technology to... Do surgery. Yeah. Just in my career alone is quite remarkable how much it's advanced. Yeah. And I expect, you know, in my lifetime for it to just get better. Right. Oh, absolutely. Like phenomenally
SPEAKER_02:better. Look where it's come from what we just talked about with the arms and whatnot. Exactly. I want to get into more into the precision, the precision medicine, correct?
SPEAKER_03:Yeah.
SPEAKER_02:What is that all about? And tell our audience where I know you're a big part of it. I know you do some things in conjunction with the Mayo Clinic. You guys sort of coordinate with each other
SPEAKER_03:on that and get into that a little bit. So just in general, precision medicine... is all about getting the right treatment for the right patient at the right time. So getting the right diagnosis, utilizing all the tools that we have available to us, and making sure that diagnosis has less chance of being incorrect. And then once we get the diagnosis, to make sure that we select the treatment that's going to work the best for them, rather than kind of taking an old school, well, we're going to try this, see what happens, and then fail. And so precision medicine is... I would say it's a new but old concept, right? Doctors have been trying to do this for hundreds of years. Since the beginning of medicine, we've all been trying to get better and hone the skill. But just couldn't quite get over the hump. We needed a little bit extra stuff, right? Yeah. I'll give an example. Initially, all we could do is just see you and touch you and say, okay, I think you have this problem. Make a prediction almost. Make a prediction. And you were maybe 50-50 right. If you're right, you're a genius. If you're wrong, it's not great. It's not so good. I would say in the 70s, 80s, we started adding a lot more kind of diagnostic labs. So you get blood drawn. They can check a few things on it. And that was actually pretty remarkable. We could, for the first time, say, okay, this is what we think is going on. Even in the 60s, 70s, we could tell you
SPEAKER_02:had some infection. Is that what we call markers?
SPEAKER_03:Yeah, even like basic blood markers. Exactly. Or even just you go to your doctor and you get your cholesterol checked. It's a marker of your cholesterol. And then, so that helped a lot. We advanced medicine. And then we had, I would say, the next iteration of that was x-rays. You could finally see into somebody's body and use CT scanners, MRIs, PET scans. Remarkable what that did for us. But that still got us, I would say, 70% of the way. Not 100%, 70% of the week. has their kind of medical record easily searchable. That took 20 years of effort, so it's not something that happened in a lot of insight. And that allowed us to then say, okay, we have all of this amazing data about millions of patients of ours, over 20 years of being treated at Mercy. And so how do we use that to make sure we're making better predictions? Okay, and so when you think about The weather is a good example. We've gotten pretty good at predicting the weather, which is not easy. Well, maybe not the best.
SPEAKER_02:Maybe not too great around here, but maybe in other parts of the country they're better.
SPEAKER_03:Exactly,
SPEAKER_02:exactly.
SPEAKER_03:But overall,
SPEAKER_02:we're doing pretty good at it. Yeah,
SPEAKER_03:absolutely. But that takes into account a lot of data. To make predictions, you need data. Stock market, whatever it is, you want to make predictions, you got to have historical context. And so when we joined the founding members worldwide with Mayo Clinic, we combined our Millions of patients' data, de-identified completely. Nobody can identify you on there. It's all de-identified data. With Mayo, we have actually now put together probably what I would say is the world's largest database of patient information. that you can use to make insights about a person's life. And one of those examples would be is a project that we've worked on in a company that came from that platform called Lucem. And what we've been able to do is say, OK, within our patient population, we have, let's say, 3 million patients right now that see Mercy. We can say, in St. Louis region, which of those patients are the highest risk of probably developing a colon cancer. And we look through our electronic medical record, run this kind of algorithm created from the model, and it'll narrow it down to say these thousand patients, man, out of all these tens of thousands of patients, these thousand, they need to get a colonoscopy tomorrow. Wow. Isn't that remarkable? Right. Whereas before, you didn't know. That's precision. That's precision? That's precision. So that's one aspect, using the data. Now, the other thing that is really cool is we've been able to adopt also 20 years of research. So that was data, but 20 years of basic science research into the fields of genomics. And now this is really the fruition of 20 to 30 years of work, and we can make it so that In the past, for example, St. Louis is very famous, actually. We mapped the first human genome in the world. A lot of that work was done at Washington University downtown in the Genome Institute, McDonald Genome Institute. And what's amazing about that is that project was worldwide. You may have heard of Craig Venter. He was a billionaire that helped make that happen. And it was a worldwide project. It cost billions of dollars and took almost a decade to get the sequencing on one human being.
SPEAKER_02:Oh, wow. So
SPEAKER_03:20 years later, we can sequence your DNA from a little sample of blood or saliva or hair, take about a week, and probably$1,000.
SPEAKER_02:Yeah. Isn't that amazing? Yeah. Hold that amazing thought. We'll be right back to the Supper Club after these messages. Kuna Food Service, providing quality food to people across the Midwest, is part of our rich history at Kuna because food brings people together. We specialize in having a large variety of food products and food supplies catering to an array of businesses that turn to us. Kuna Food Service, a family-owned tradition since 1918.
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SPEAKER_03:Yeah, so we talked about how We went from over decades of work to sequence somebody's genome. It took billions of dollars in a decade. And a lot of time. A lot of time and a lot of people's effort. And now, within a week, and for usually less than$1,000, we can sequence their genome. And what does that mean exactly? Well, one of the tests that we launched recently in the last two years through a company called Gallery and Grail, the Gallery test through Grail. And that took several years to do, but it used kind of the work of sequencing, meaning we take your blood and we kind of break it down and look at really the deep depths of the DNA within it. And not just the markers, which are more superficial, but the deep depths of the actual DNA. And then we can predict... and say with a reasonable certainty whether somebody has a sign of cancer at a very early point. And what's remarkable is this, and this is why that matters. Whenever you have a disease that you get affected by, it's so much worse if you catch it when it's later on. Whether that's Alzheimer's disease, whether that's diabetes, whether that's heart disease, and whether it's cancer. I call those the four horsemen. Those are some of the worst things you can have that are more common in our society. And whenever you get diagnosed with those later on, it's extremely difficult to manage and treat. And it affects the patient's life, it affects their family's life. One startling statistic that for my patients that are afflicted with cancer, about a quarter of people who have a later stage cancer go bankrupt.
SPEAKER_02:Oh
SPEAKER_03:yeah. It's remarkable. I know. So you add to that, not only are you diagnosed with a later stage cancer, But now you can't work, you can't support your family, and
SPEAKER_02:you go
SPEAKER_03:bankrupt. That's
SPEAKER_02:what I do with my foundation. The money goes to help these folks because somebody ends up losing a job either because they're too sick or they have to stay home and take care of a spouse or the kids. It's just within the family unit. And guess what? Half the income's gone. Half it's gone. So now the bills start piling up. So you've got that stress on top. You've got financial stress on top of it. health stress. Exactly. So I'm glad that... To
SPEAKER_03:your point. But that's an amazing thing that we have... community partners like yourself that support the patient along their journey you know and hey we're not just going to treat you but we have other ways of lifting you up while you're getting the treatment
SPEAKER_02:and we talked before we went on we talked about you know some of the great things about St. Louis and different areas but that's one of the things about the people of St. Louis they're always willing to help whether it's if it isn't money it's their time their talents whatever it might be to help out it's just we're a great community in that respect.
SPEAKER_03:So yeah, to your point. Well, that's why I came back and that's why I intend to spend the rest of my life here. I love it. Well, home's always home. Home's always home. So I think the picture I was setting up is that we really want to do early detection, right? We don't want any of these diseases to be caught later. And so if you can catch something when it's super early, like stage one of something whether it's stage one kidney disease alzheimer's diabetes or cancer or even what i would call pre-cancer or pre-diabetes right when you catch it then you can do something about it and has a less impact on your life and your family's life and so that's where these genomic sequencing tests are coming into place yeah and so when we talk about the gallery test it's essential and really important work because right now We only screen for five different cancers. The United States Preventative Service Task Force, we screen for colon cancer with colonoscopies and some stool-based tests. We screen for breast cancer with mammograms, prostate cancer with PSA tests. We screen for cervical cancer with pap smears. We screen for some lung cancers with low-dose CT scans of the chest. And of course, you have skin cancer screenings through regular checkups. And so the issue with that is that there's another 60 or 70 types of cancer that we have no screening for. Sure. You know, pancreatic cancer. Yeah. Bladder cancer. Which I treat. Big one, yeah. Kidney cancer. There's no screening for it. So whenever you catch those, sometimes it's at stage three or stage four. And then it's much harder. Yeah. And so this gallery test, what it did was is, and it's remarkable because the science behind it is really cool. So... What they found was that when you look at the DNA in the blood, a normal cell fragment of DNA is much larger than a cancer fragment. So the cancer fragments are really smaller, smaller fragments by size. These are tiny little things that they could find. And they found that- Now, before, no way.
SPEAKER_02:Oh, we couldn't find it before. Now, let me ask you. Now, is this done with just a simple blood test or is it a combination of a blood test, hair sample, and saliva? Simple blood test. Or just a blood test? Simple blood test. It's at our
SPEAKER_03:Center for Precision Medicine
SPEAKER_02:at
SPEAKER_01:Mercy. And
SPEAKER_03:we have amazing nurses and nurse navigators and nurse practitioners who are there to answer 100% of our questions.
SPEAKER_02:Nurse navigation? Huge on that. Remarkable. And I tell people, because people will call me and say, hey, I got a friend of mine who just got testicular cancer. Do you mind meeting him for coffee and talking to him and stuff? I'm like, yeah, no problem. Happens all the time. I'm more than happy to do it. And one of the things I tell them is bring somebody with you. 100%. Bring what I call a health advocate with you when you're talking to the doctor because You're a deer in the headlights. There's a lot. He's going to be talking to you, and you're going to walk out of the room and forget everything he said or she said. So to your point, now mercy has a built-in. navigator for you if you don't have a family member or a close friend to go along with
SPEAKER_03:you. So important. I actually think it reminded me. I think it was about seven or eight years ago that I had to present a navigation program in front of the Mercy Foundation, and you were sitting next to me. Oh, really? Because I remember
SPEAKER_02:now. I was going to say, because that came out
SPEAKER_03:right when I was serving on the board. And so I remember saying to the board, the big board, and I said, Okay, because at the time it was just a pilot. I did the first pilot for Navigation in All of Mercy. And I made it work and we had a great navigator. And I presented to the board and I said, and you sat next to me and you said, This is what we need to do. And now we have almost 15 Navigators because of the work you guys did raising the money so that we can have it. Anyways, that was a... I
SPEAKER_02:remember. I specifically remember when that came out during my tenure on the board. Yeah, it was just a great idea.
SPEAKER_03:But back to the test. So basically, you draw the blood, and it looks at the science behind it. It looks at the DNA fragments, and it can say with high accuracy... Yes or no, do you have cancer right now? Not in the future, it only tells you right now. it can tell you where it's coming from potentially. And so to date, we've done about 4,000 tests at Mercy, and we've had about 20 patients who are positive for that test that we worked up with other scans and biopsies and found cancer earlier in some cases, and we're able to treat them. Now, this is the first version of the test. It's going to get better and better. We do have a study open at Mercy that if people are interested, they can be involved with that study and call the Center for Precision Medicine and see if they're eligible And it's also, obviously, right now it's not fully covered by insurance, and so it is a test that does cost money currently. There's current legislation. We actually testified before Congress. A member of my team, Dr. Jay Carlson, testified before federal Congress about our program at Mercy, and several of the senators were very positive about it. And so we hopefully will have some legislation that says, hey, this is an important test. Military folks can can be having higher access to the test now because TRICARE covers it now. And so it's starting to get covered. But right now, out of pocket, it's around$950. And we would recommend
SPEAKER_02:it. You know what? Worth every penny. I mean, why wouldn't you do it? And here's my next question. At what age should people have it? I mean, when you're 10 years old, should you have the test done to see what you might have? possibly happen to you in the future? Is that
SPEAKER_03:what we're talking about? One clear thing on this is this is not telling you what's happening in the future. It's only telling you today if
SPEAKER_02:you have cancer or right now.
SPEAKER_03:There's other tests for the future, which I'll talk about in a second, but to answer your question, the target population for this test is people above 45 or people who are extremely high risk for the development of cancer. What makes somebody high risk for cancer? age is the number one factor. So the older you are, basically that's a risk factor for developing cancer. The second and third and fourth most important things are Exposures. Your environment. Your environment. So if you're a smoker, that's obviously part of your exposures. I have patients who are firefighters, patients who are military veterans who worked in the Gulf War and had exposures to toxic chemicals there. People who are factory workers in different areas where they're exposed to a lot of toxic fumes, asphalt workers, welders. I have patients who have a family history. So if you have multiple family members who have had cancer, you're a little bit higher risk of developing cancer. Since it is near and dear to my heart in St. Louis, there's a few areas in St. Louis that are hotbeds for cancer, which is an area of St. Louis called
SPEAKER_02:Coldwater Creek. I helped out a young lady who was a cancer carrier because of that. That's nuclear waste. She's on my website, and she passed away some years ago. But, I mean, she really fought it. I mean, I've never seen anybody fight it like that. Coldwater Creek,
SPEAKER_03:Weldon Springs. So we know that, and what's nice about those areas is there is some legislation, just so everybody knows, that's being passed by Senator Josh Hawley. Sure. And they're going to vote on it. Hopefully it passes. That should help at least those people afflicted by these radiation areas mitigate the cost of what's happened. Help them get screened. Because if you know you're higher risk, the least we could do is screen you more. It's all about prevention first. If you can't prevent it because you're exposed, screening, right, and screening for every type of cancer, not just the five, and do it often and early so that you could do early detection. So prevention, screening, and early detection is the key.
SPEAKER_01:Yeah.
SPEAKER_03:And that's for
SPEAKER_02:any problem. I remember in my own case with testicular cancer, I had it twice. There was some sort of correlation where your testicles didn't descend at birth. That's true. With people, with guys getting testicular cancer. And then much later on, that was when I was diagnosed with it, they had told me that, they weren't really sure. But then there was a test that was done in France where there was a correlation between people who lived or were born and raised in coal mining towns that their testicles did not descend. I thought that was kind of interesting. Oh, very interesting. Yeah.
SPEAKER_03:I mean, the more and more we're going to learn is that these correlations are not just accidental things. We're going to know more about that. Sure. And so— one thing we talked about was the data part right so we can predict using large amounts of data to say okay this person may be higher risk of developing diabetes this person may be higher risk of developing colon cancer and then we talked about the genomic aspect sequencing DNA and being able to tell you do you have cancer yes or no right now for cancers we don't screen for but one thing you mentioned which is how do we determine the future risk yeah right and so One of the tests for cancer, at least, that we do at Mercy and other people do offer it is what's called germline testing. Okay. So one thing that it's a difficult concept to understand, but I'll try to make it simple. But basically, there's two types of things, cells that kind of are mainly in your body, somatic cells and germline DNA. So somatic DNA is kind of like... is DNA that you've acquired over your life, right? Okay. You get exposed to the sun. Not what you're born with. Not what you're born with. What you develop over the years. What you develop over time. So germline, though, is what you're born with. Okay. So basic, right? Germline, what you're born with. Somatic, what you've acquired.
SPEAKER_01:Okay. And
SPEAKER_03:so an example is that if you have multiple family members who've had cancer, there's a possibility that there's a germline... DNA problem that's being passed on generation to generation. And so before, we couldn't test for that. We just had to say, well, your grandma had it. And then we had patients who had no clue about their family history or were adopted. We don't know their family history. And so one of the things that's nice is this test now is available, and a lot of insurances do cover it actually, in the right indication. And so if you call, again, our Center for Precision Medicine, our nurse navigators will guide you through the process. We actually have an app too, you just click through it, and they'll tell you, hey, you qualify for the test, it's free. And what it does is it tests for 70 or 80 different germline mutations. And what's good to know is that if you're tested positive for one of those, it doesn't mean you have cancer, it means that, hey, There's a higher chance you could develop it in your lifetime. We need to screen you. You know, my wife, her sister and her mom both developed breast cancer. Sure. My wife got tested for the germline mutation. Luckily, she tested negative. Yeah. But she still has a higher risk of developing breast cancer in her lifetime because her mom and sister got it. Right, right. And so instead of saying, well, we're going to do traditional screening, she qualifies for... More screening. So every six months, I know it sucks because she's young and going to the doctor that often when you're young, it doesn't feel right. No, it doesn't. But every six months, she has to get a mammogram and then a breast MRI. And when we talk about it at home, we're like, hey, this is so much better than if we didn't do that. And then let's say something happens and we catch it later. And so my emphasis to the audience and everybody is basically that it's worth it to get tested. It's worth it to get screened. Absolutely. Because getting checked early is way better. And one example I always tell my patients is when you buy a new car, right? Man, I would say this. People take care of their cars much better than their health. No question. You're not missing that oil change. I know. You're getting your car, you're getting your tank of gas,
SPEAKER_02:you're getting your tires rotated. I'm going to take it to the car wash about eight times a week. Exactly. Get out and dry the wheel. Dry it up and stuff.
SPEAKER_03:We don't
SPEAKER_02:do
SPEAKER_03:that to our own bodies. We don't do that to ourselves. It's like you should at least get checked under the hood with your own body every couple months. Just get checked out. See what's going on. And we have better ability. What's really nice about these tests, Joe, is that Yeah. You can do these from the comfort of your home now. Yeah. These tests, you don't actually have to go into the doctor. Really? We actually offer these tests through a phone call. Wow. You go to the lab. We can even send somebody to your house sometimes. So these tests are what I call are democratizing health care, meaning that I have patients who can get these tests who live in Ironton, Missouri. Sure. You don't have to just live in St. Louis. You don't have to just be close to Mercy. You don't have to drive up to St. Louis. You don't have to drive. I have a farmer that I took care of for years that had bladder cancer. And with cancer, now this is, we do some of these DNA-based tests after you've been diagnosed also, not just a screen. And so that's part of precision medicine where we can say, okay, you've been diagnosed with cancer. We'll sequence your DNA and say, hey, what's the best treatment?
SPEAKER_01:Yeah.
SPEAKER_03:So this guy actually had had multiple treatments, had done surgery, removed his bladder. He had an ostomy from that. Wow. And he was close to reaching a point where He had to give up. We had nothing left. Was this a gentleman with stage four cancer? He had stage four cancer. Okay, I was going to ask you about him. And so he was a farmer, a cattle farmer in a kind of remote area of Missouri. And basically, amazing guy, real zeal for life. He's 80 years old, but real zeal. He still was taking care of 60 cattle. That's not easy. Working a farm. I take care of two little kids. It's hard. He has 60 cattle. I can't imagine. And so... You're herding kids, he's herding cattle. I'm herding kids, he's herding cattle. And so we sequenced his tumor DNA, and we found a very rare mutation, and we tried a drug specific for that, and he went into remission. And you nailed it. And he had an extra year or two to live. Oh, wow. Isn't that remarkable? That's great. And he had an amazing next year or two of his life. He lived it up, and he had that time, whereas he would have died otherwise. And so these things are having direct impacts in people's lives. I have patients who, for instance— Another great story, if we have time for this one. So this patient had been diagnosed with prostate cancer. We did genetic testing. We did his germline test to see, is this something he could pass on to his family members? Because his father had had prostate cancer. So we did it not necessarily for his treatment, but to know for his kids, is this something to worry about? So we did test him and he ended up having a mutation that showed that he does have this kind of rare mutation. called ATM. And this means that his family was at risk.
SPEAKER_01:Wow.
SPEAKER_03:And he had three daughters. And what's interesting is a man with prostate cancer who has multiple generations with prostate cancer, his daughters have a slightly higher risk of breast cancer. Really? If they have this mutation. Okay. And so we tested all of his daughters. One of his daughters tested positive. We did a mammogram immediately. Right. And what was really good is that we found a stage zero breast cancer. So early that she was cured.
SPEAKER_01:She was cured.
SPEAKER_03:Basically her father essentially saved her life. If he didn't get tested we wouldn't have known. And we would have caught it maybe later. So she got caught super early. I want
SPEAKER_02:to get into the area where you guys have done all this breakthroughs with Mayo Clinic. How do you then share this information with other health care systems?
SPEAKER_03:Oh, 100%. That's a great point. So one thing that we've done with this, what's called the Mayo Clinic platform, where the founding members is, We're constantly trying to add hospital systems to it to get more data the more data you get the more robust the model becomes right and so we've actually added not just hospitals in the united states we've added international hospitals oh really so a major hospital system amazing hospital system in israel called sheba okay is another member okay we have a hospital system in in brazil einstein medical center there that is a member we're adding members in the United States as well. And so when we add these members, they have immediate access to a lot of these algorithms. And not only that, as the science gets better, we try to publish some of the data. Some of these algorithms get published in a way that other systems can understand it. But I would say that the nice thing is this. If you choose Mercy, which has a huge footprint all over four states, then any patient who chooses Mercy gets immediate access to this. Right. Because you're one of the pioneers. Yeah, behind the scenes. The patient doesn't have to even ask for it. They're not like, oh, I want to get this test. We're running it kind of always in the background. A good example is recently, and this is really cool, actually. I was able to work on this, kind of one of my projects with our teams, but it was a really satisfying project, was... There's a company that came from this platform called AI Doc, D-O-C, AI Doc. And one of the problems that we face is we have a lot of patients, we have fewer doctors, and we have less time in general to take care of people. It's a tough problem. And so we utilize this amazing software that was made by this company out of the platform called AI Doc that It takes every x-ray that we get through at Mercy. So if you go to Mercy and get a CT scan or get an x-ray of your chest or something or a bone x-ray, your radiologist reads it still. But before the radiologist reads it, the AI reads it too.
SPEAKER_01:Oh, wow.
SPEAKER_03:It's like a little angel sitting on your shoulder, the radiologist that says, hey, the AI looks at it and says, hey, I see maybe a blood clot in this person's lung.
SPEAKER_02:Is the AI based on all this data you talked about? All the data. That's how it was
SPEAKER_03:key. It has to be the data. Without the data, it's not good. If you have data based upon like five people, it's not great. It's not going to be very effective. But this is over millions of patients. Taps into all that data. Exactly. And so it taps into it and recognizes the pattern. And the radiologist can then say, with a little bit more confidence potentially, hey, there's actually a a blood clot here. And then that result gets quicker and more active. With mammography, hopefully we'll release that. When a woman gets a mammogram, before she leaves, we'll have a result. I mean, how remarkable would that be? You go home usually, you wait, you're anxious. Hopefully, if the program goes well, we'll have it so that these things are creating much quicker
SPEAKER_02:care. You know. You don't have to sit around and wait. Exactly. And you know with confidence.
SPEAKER_03:More confidence that, hey, If you had to choose basically, should I go to the ER that doesn't have this running in the background or the ER that has it running in the background? I mean, it's a no brainer for me. I'm gonna go to the place that has not just the radiologist, but this is also running in the background.
SPEAKER_02:Not that cancer is not important. I know that for sure through my own experience, but let's get into the precision medicine where it relates to Alzheimer's today. which is a horrible disease.
SPEAKER_03:It's a tough topic. I think that one of the things that I realized is I was taking care of a lot of patients. I still am in surgery. And when a patient has to see me, it's usually not great, right? I'm the surgeon. They've caught the cancer a little bit later. I have to do a major surgery. And I mainly do kind of bigger surgeries. So when I saw that this precision medicine stuff was burgeoning, the field was burgeoning, meaning it was becoming ready for primetime use, I was very excited about it and tried to adopt it into my practice really early. But then also, I was also getting older myself, right? I'm 43, but I'm still young, but I would say I was getting older. I have two kids. And what I realized is I need to live a long time. I have little kids. I need to live a long time to see them get married. Right. You have kids. Yeah. And so that means I have to do things to, one, catch things earlier, but also make my body healthier. Yeah. Right? And so what can I do to do that, right? Exercise, eat right. Sure. But then also understand my genomics, right? Understand what my DNA is. Understand what could happen to me. And so Alzheimer's is one of those things where it's so important to understand because whatever you do today could affect 20, 30 years later. And if you develop Alzheimer's, it is such a tough disease on you, but also all of your loved ones around you.
SPEAKER_02:I've seen some people close to me, friends of mine, my family, who've had spouses go through it. Recently just lost a friend, more of a friend of my... I know them, but more a friend of my parents. And it's just... It's terrible. It's just horrible.
SPEAKER_03:It's something we have to try to figure out, right? Oh, absolutely. And so we do have... I was really proud of last year, we put on our first Precision Medicine Summit, and I'm gonna invite you to the next one. We made it, it was smaller the first year, but it was really a success, and we announced a lot of our partnerships, we presented some of these cool tests and data, and we had some really, amazing interactions with some of the most innovative companies I've ever seen in my life that are making these tests. And one of those companies is actually a company local to St. Louis. Again, we're lucky. We have amazing research universities here, SLU
SPEAKER_01:and WashU.
SPEAKER_03:And one of the companies that came out of St. Louis is called C2N. And this company has been spotlighted in Wall Street Journal, Time Magazine, one of the greatest inventions of our time. They've made a test that hopefully we'll adopt at Mercy soon that basically can predict potentially with some high level of accuracy about whether somebody would develop Alzheimer's 10, 20 years from now.
SPEAKER_02:Yeah. I was going to ask you how early. So maybe 10? So early enough, potentially. The most 20 years out? I think so. And so you can start doing some things to try to head that off with the past. If you knew that,
SPEAKER_03:right? It's a philosophical question in the sense that... Right now, we don't have a ton of medicine to prevent it. Now, the company is working with pharmaceutical companies to think about the pathway of potential interventions with drugs that can help, like different pharmaceuticals. But otherwise, things like lifestyle... diet you know avoidance of alcohol potentially right because keep keep keep
SPEAKER_02:just like any other muscle in your body exactly
SPEAKER_03:work out
SPEAKER_02:the brain exactly read books you do
SPEAKER_03:puzzles exactly you know what i mean and so thinking about kind of like being able to predict 10 to 20 years in advance of alzheimer's we can start potentially modifying somebody's life in a way that may have some impact on them developing that disease. And maybe along the way, as drug targets become developed, where we can say, hey, we know you're in that highest risk group that could develop Alzheimer's. We should start you on this medication that can prevent that.
SPEAKER_02:It
SPEAKER_03:would be a no-brainer. The disease is so bad that anything that could do to slow it down
SPEAKER_02:would be
SPEAKER_03:remarkable. So Alzheimer's is something we're working on now at Mercy to adopt that test. Another kind of similar thing is diabetes, where there's drugs now for type 1 diabetes that 10 years in advance of getting type 1 diabetes, you can do tests to figure that out and then take a medication that could prevent you from developing type 1 diabetes. So what I really like, the coolest part about this precision medicine for me, even though I'm in surgery three to four days a week, seeing patients the other days, it gives me hope. And what gives me hope, I pass on to the patients and say, listen, we have these things coming out. I get to meet with... All of these amazing, innovative companies
SPEAKER_02:every week. Right here in St. Louis, apparently. Right here in St. Louis,
SPEAKER_03:a
SPEAKER_02:lot of them. Which nobody knows about. A lot of these amazing companies. We have great restaurants, but nobody knows about this. Yes, exactly. You're right. We were just talking about it. We need to
SPEAKER_03:brag about this stuff a little more. And speaking of that, I do want to say another name of a company because it's local. Sure. A company called Genoscopy. Okay. Genoscopy is home-bred. The founders are brother and sister. Brilliant people, Andrew and Erica Barnell. And Mercy's formed a big partnership with them. And they make a stool-based test that screens for colon cancer. Is that the one you see, the commercial? That's Cologuard. Theirs is a competing test that uses RNA that actually has a little bit better data, in my opinion, that actually can also screen people better when they're a little bit younger. between 40 and 45 so I'm really positive about their test and we're trying to roll that out in Mercy because we really think it's a great test and the two founders Andrew and Erica Barnell I mean they're dynamos they're amazing people they're born and bred you know St. Louis people and they were just amazing brought up through the incubation system that, you know, St. Louis has an amazing entrepreneurial
SPEAKER_02:spirit. You know what? It's an amazing entrepreneurial spirit. Yeah, we really do. But, I mean, here's two people that largely are unknown by the other people, you know, that live in St. Louis. Exactly. Don't even know about it. So, definitely something to be proud of, you know, no doubt. 100%. And the other company as well. 100%. You know, so, kudos to them and St. Louis is a big part of it. Hey, they were born and raised here. We must have did something. Exactly,
SPEAKER_03:exactly. I think that a lot of these tests we're excited about because, yes, they're from St. Louis. A lot of the startup that we kind of interact with have come from this area. And I think Mercy is really lucky to be leading the way. We're kind of lucky, and I'm lucky to be part of
SPEAKER_02:this. It's nice that they thought of you and came to you. Mm-hmm. and wanted to partner up, that says a lot about Mercy, too. I agree, 100%. Because I'm sure they're very familiar with all the different hospital systems in and around Missouri or wherever, and they chose you guys. Exactly. Probably because what we talked about at the top of the show, the culture. 100%. At Mercy.
SPEAKER_03:I would say this, not to brag about Mercy too much, but I will a little bit more. Why not? Exactly. I would say that when we interact with a lot of the, not just St. Louis startups, but I would say... United States startups, and then the AI doc company is actually Israeli startup. So worldwide, we're interacting with some of the, I would say, brightest minds in the world.
SPEAKER_02:Wow. Right here in St. Louis. Right here in St. Louis.
SPEAKER_03:They come to St. Louis to see us at Mercy.
SPEAKER_01:Yeah.
SPEAKER_03:On a regular basis, because we show them the one, the St. Louis hospitality, The culture of Mercy being, hey, patient first. This has to have an impact on our patients first before we consider this as a good product. Most of the companies email us back saying, I mean, this was the best experience we've ever had with a company. One, because we had good leadership, we had good planning, we showed them what our culture is, we showed them kind of good hospitality, and I would say, when they work with us and they actually help their product become a little bit better for the patients. Sometimes you could make something, but until you actually see how it affects the patient, you don't know if it's going to work. And so the way we do it, we take that stewardship really seriously at Mercy where we really only allow products and companies that we think and have been shown to be really safe and effective for patients.
SPEAKER_01:I mean,
SPEAKER_03:I would say for everything we do in precision medicine that we adopt, we reject about 99%. Oh,
SPEAKER_02:really?
SPEAKER_03:Oh, yeah. I mean, you would be surprised at how many meetings we have that we basically say, I don't think this product is helpful. It's not good. It's not necessarily accurate. It's not going to be helpful to our patients. So the majority of the time, we're very selective in saying this is good enough to be for our patients.
SPEAKER_02:I'm going to switch gears on you one more time. Talk about how it's now affecting autoimmune diseases. The precision medicine is helping out in that arena as well.
SPEAKER_03:So that's a very good question. So most of the dollars for research nationwide and worldwide first get prioritized to cancer, I would
SPEAKER_02:say. So
SPEAKER_03:when we see that, cancer and I would say heart disease. So those two diseases, we have probably the most testing. The four horsemen that you mentioned. Yes, Alzheimer's and diabetes. Autoimmune disorders, I would say, unfortunately get a little bit less funding.
SPEAKER_02:A little less status. And so
SPEAKER_03:because of that, the testing for that has lagged a little bit.
SPEAKER_02:Okay.
SPEAKER_03:And I would say that right now within precision medicine, We don't have any perfect holy grail tests that we see right now. But I would say once we get into what's called whole genome sequencing, where right now we're selectively sequencing to say, is there a higher risk of cancer? Is there a higher risk of this? Is there a higher risk of this disease? But once we get into more looking at the person's entire genome and saying, what are the similarities in people who have... lupus, rheumatoid arthritis. What are the similarities they have in their DNA? Yes. Can we predict that? Yeah. I think we're going to see those tests come out. But right now, I would say we're kind of not
SPEAKER_02:prime time yet. Okay. All right. But
SPEAKER_03:I'm excited to see as that progresses.
SPEAKER_02:Well, you know, the way things are moving now, as quickly as they are, you know, when you talk about the timelines, you know, with even robotics and whatnot, it's just... The space and time keeps getting shorter and shorter with these advancements. It's incredible. It really is.
SPEAKER_03:I would tell people who are interested in the field of medicine, it's a really good time to be a part of it because you're seeing an amazing transformation of utilizing kind of the best the world has to offer from technology and genomics. And at Mercy, I feel like you can combine all of that and still have that really essence of what it really means. At the end of the day, it's just me talking to you. Yeah. Just like this show, right? Right. At the end of the day, I have all these tools, the robot, the genomics, the artificial intelligence tools. Sure. At the end of the day, it's me, you know, saying to Joe, you know, God, I'm talking to you and saying, hey, let me just listen to you, you know, give you a hug or or listen to you and really show the compassion that bedside manner what they call exactly is so important you have to connect
SPEAKER_02:you know i've heard a lot of cancer patients you know what no matter where they live or whatever have always you know had a doctor where that piece was kind of was missing they just didn't feel like it was just very a matter of fact and out the door. You know what I mean? It makes a difference. That's not the experience at Mercy. You guys are all really good about that. I don't know if you guys have a whole seminar each year. Or it's just handed down from generations of doctors and nurses down to the newer ones. I
SPEAKER_03:think it's something that you have to be intentional about. When I first started you model other people, you develop your own kind of pattern for how you want to take care of people. Or style. Style. Yeah. But I think that, you know how businesses kind of check in every quarter? Sure. You look at your earnings, you look at this. Right. What I realized is, and I started doing this maybe seven or eight years ago, I kind of check in with myself every three months. Right. To say, okay, am I... spending time with my wife enough? Am I doing the things to keep that relationship good? Am I doing the things with my friends and my family and my kids? And then, am I treating my patients the way I've always wanted to? Because unless you check in and recalibrate, I do think there's a potential that it can go down. Because if you don't intentionally say, okay, you know, am I practicing medicine the way that I really
SPEAKER_02:wanted to practice? There could become a separation. You could
SPEAKER_03:become separated. Right. And I think that 100%, you create that culture, right? And so whether that's your mentors at Mercy, previous doctors, whether that's different leaders there, whether it's a sister. that happens to be there, right? Right. Or whether you look at a quote from a sister or whether you get inspiration from a patient or just thinking about a success you've had with a patient from the past. You have to recalibrate. Just focusing on the
SPEAKER_02:human aspect of the whole thing. You have to do that. You have to do
SPEAKER_03:that.
SPEAKER_02:And it takes time. You have to pause. Yeah, because that's really what it's all about. A hundred percent. A human aspect. A hundred percent. Humans helping humans. Exactly. I always joke, I say it. I mean, it sounds kind of, you know. pretty elementary, but that's what it is, basically. It's what it boils down to.
SPEAKER_03:I'll joke around sometimes and say, if you take away everything that we have in medicine right now, the technology, you could even take away the building. At the end of the day, like you said, human taking over human, I could be in my backyard with you and say, hey, what's wrong with your leg? I'll look at your leg, touch it, and say, okay, let's figure this out. That's the human aspect. You trust me, you figure it out. Obviously, it's a lot nicer to have the other stuff because we got to have that to make a more accurate diagnosis. Like you said, at the end of the day, it is a truly just person-to-person endeavor.
SPEAKER_02:Yeah, it's kind of like going back to the old days. Have you ever watched Little House on the Prairie? There was that doctor. I don't know what his name was. Yeah, I know what you're talking about. He'd have his bag and he'd make farm calls, I guess, or what we call house calls. Exactly. That's kind of what it is. It is. And they're in the community. They know the people. And so when they're coming to see, you know, if you do get ill or sick or break a leg or whatever it was, they knew the guy already when he was coming. And so there's kind of that, again, it's that human aspect, that human interaction. It's so important.
SPEAKER_03:There's something like, and obviously you're in the hospitality and restaurant industry. And I always think to myself that, you know, There's a reason I go to the same restaurant a lot, right? Because when I walk in, I trust that person. That's right. I know the food's going to be good. That's exactly right. They come out with a smile. We talk. You know, one of my favorite places to go in town for brunch is this place called
SPEAKER_02:Egg. See, I told you it turned to food. We have to talk about it.
SPEAKER_03:Huh? We knew it. But anyway, go ahead. But this brunch place that I go to, I've been going there for 10 years. It's called Egg. Okay. And it's in, there's one in Midtown and there's one in Lafayette Square. Okay. It's owned by this guy, Lassad Jaliti. And he also had this place, Bar Italia, near.
SPEAKER_02:Oh, sure. Yeah. In the central West End. Got a great patio. Nice patio. The best patio. You sit out there. Oh, it's awesome. And the sun's going down. It feels
SPEAKER_03:good.
SPEAKER_02:And you look, and the Chase building looks like the building in Ghostbusters.
SPEAKER_03:Oh, yeah. You're right. You're
SPEAKER_02:right. It really does. But really, it's a beautiful, beautiful place. Beautiful setting out there. Yeah, those guys, they do such a great job. And that patio is probably one of the best patios in St.
SPEAKER_03:Louis. Oh, I love it. Yeah, so you have that. Bar Italia. And then he has the egg. Oh, really? So they own both of them. It's a brunch place.
SPEAKER_02:I'll be darned.
SPEAKER_03:And so this guy, so I started going there. I went there by myself first. My wife, we were dating at the time, and she was in Florida still. And so I went to breakfast, and I met this guy. The owner was there. And I tell you, man, the way he treated me and the way he talked to me, Instant connection. He had that bedside man. Yeah, sure. And for 10 years, 10 years now, we consistently love to go there. Even if we've missed a few months, my kids go there. He knows their names.
SPEAKER_02:Knows what you like to eat. Knows what you like to eat. Knows what you want to drink.
SPEAKER_03:He's amazing. And then he's done special private, my birthday party, my wife's party. Oh, really? See? He never rented it out to anybody. He did that for us because we've known each other, right? And that type of connection is something that is the human connection you talk about. And it transcends like any transaction, right? Whether it's medicine, whether it's a transaction at a restaurant. And I think if you can get to that human connection, whatever you do in life, if you can get to that human connection, life is better. I
SPEAKER_02:believe those guys are Ethiopian. You're right, you're right. And they have an interesting story, too. I mean, they fled Ethiopia. Ethiopia, I think, because apparently, they were pretty high up in the hierarchy. They were almost like, yeah. And they lost everything. Like, they had to leave everything. And they came over to this country with hardly, I don't know, a dime of their name. When they came from an area where they were like, they had everything. I mean, they were well-to-do. And then here they are. They start the restaurant. But to your point, the human element. You go to a restaurant. Sometimes when your wife and you decide where you're going to go eat, you don't even name the restaurant. say, let's go see Keith at his place, or let's go see Terry, the waiter you like to— You name the person and not the business. Exactly. Because, again, it's about people. Exactly. You're right. So, yeah. You're right. Yeah, it's a very good analogy, and I knew we would go— We had to get to that. We would talk about food at some point. Exactly. Yeah. Well, anything else you want to share with us with— With precision medicine? Have we touched all the bases? Because it's been very interesting.
SPEAKER_03:I think one of the most important things, just to reiterate, is it's super important to... Do prevention, so preventative care like we talked about. Try to re-examine your life every few months and say, am I eating the way I want to? Am I exercising? Do I have the energy I want? So kind of look at your own body and say, are things feeling right? So that's part of prevention. Get tested. Go see your Mercy doctor or whoever you're seeing and get the screening tests that are available. Because I can't emphasize more than enough is Early detection is the key. So early detection through traditional screening, early detection through what Mercy's what I would call enhanced screening is through germline testing we talked about, the multi-cancer early detection test that we talked about, the gallery test. And if you do that, you're giving yourself the best chance. I think that that's super important. That's what precision medicine is all about. We're going to constantly add tests like you touched upon for potentially Alzheimer's, hopefully autoimmune disorders in the future. Sure, sure. And just know that the future is very bright. Right. And when you're feeling down, there's a lot of hope still out there. And you have a lot of great people that I work with, but all over that are looking out for you. You have foundations in the community that are going to lift you up. And so always reach out. Always ask questions. Precision medicine is fantastic. I think the future is... is going to be filled with a lot of great things for patients and for providers and everybody
SPEAKER_02:around. And it's coming at us at a faster rate. We're improving faster and faster.
SPEAKER_03:Exactly.
SPEAKER_02:And a lot of it is because of AI. And I know, personally, my own personal cancer journey, I don't have to, but I've elected to go see Doctor Who every six months. Every six months, I'm coming. And like you said, you know, Have them take a look under the hood, you know, and see and make sure everything's, you know, going okay. So, yeah. Yeah, it's good stuff. Dr. Agarwal, thank you so much. I appreciate it. Thanks a lot. Very interesting, very exciting innovations, and best of luck to you. Hey, St. Louis can be proud of you. You're one of our, you know, born and bred. It's awesome. I appreciate it. Thanks again for the time. This has been a lot of fun. Yeah, it has been good. Thank you so much. The Supper Club brought to you by Mercy, transforming the health of our communities. Kuna Food Service, a family-owned tradition since 1918. Lordo's Diamonds, your family jeweler for life. Oliva on the Hill. Ackerman Toyota, the number one St. Louis Toyota dealer in volume sales back-to-back years 2023 and 2024. Thank you, St. Louis. And Fresca Limoncello. Keep sipping, my friends.
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