Transcript
Daniel Ghinn
Well I’m so glad to be joined here by Medical oncologist at UT Southwestern Medical Center in Dallas, Texas. Welcome Dr. Begg.
Shaalan Beg
Thanks for having me. Really excited about having this conversation today.
Daniel Ghinn
great. Well could you just tell us a little bit about your current location? What’s the view from your chair?
Shaalan Beg
Yeah, I am looking out of the window and I see a road which hopefully there will be no ambulances or fire trucks that come in front of me. But it’s nice and sunny and it’s gonna get really, really hot very soon.
Daniel Ghinn
beautiful. Tell us something about what you do, how long have you done it and how did you get into it?
Shaalan Beg
So I’m a medical oncologist. So I care for people with cancer. And my specialty within oncology is focusing on GI cancers and pancreatic cancer specifically. So when we think about delivering the best possible care for somebody with cancer, we think about what are the novel treatments that are available so we can give someone the best chance possible to live their lives as well as possible for as long as possible. And we also need to keep…
our finger on the pulse in terms of clinical trials and what’s coming down the pipeline for potentially new life sustaining or life saving treatments as well. So I straddle both of those worlds, the world of clinical care and clinical research, primarily focused around the GI cancer space. But when it comes to clinical trials, my interest and passion to some extent is really to focus on ways to extend clinical trial.
access using technology, technology enabled services and to see how we can continue to evolve things in the oncology space when it comes to cancer clinical trials.
Daniel Ghinn
Amazing. When we listen to physicians on social media, I get such a sense that in the area of oncology, maybe above all other fields, there’s so much work yet to be done.
Shaalan Beg
Yeah, so there’s been a lot of progress in the last 15 years when it comes to new treatments, primarily focused on what we would collectively call immune therapy or targeted therapy. And immune therapy are cancer treatments which use our body’s own immune system to attack the cancer in a more effective way. And targeted therapies are treatments that…
Daniel Ghinn
Mm.
Shaalan Beg
that are able to exploit specific molecular changes in the cancer in order to treat that cancer more effectively. And it’s a very different world when it comes to cancer treatments than what it was in the 80s and 90s when cancer treatment was synonymous with chemotherapy, which is still used for a lot of cancers and is still fairly effective for a lot of treatments, but is a different pillar.
when it comes to treatments for oncology.
Daniel Ghinn
So what’s for you, what’s the most exciting thing that’s happening in terms of advances in your field of oncology?
Shaalan Beg
Most of the advances that are taking place, we’re continuing to see evolution in immune therapy and targeted therapy. For immune therapy, we are learning ways to help make the immune therapy treatments more effective against a wider spectrum of cancer and at the same time, trying to make those treatments safer. Because one of the side effects of the immune therapy treatments is when you rev up the body’s immune system, that it can start attacking normal parts of the body.
body as well and cause side effects. So a lot of the innovation in that space is coming into how we can broaden our spectrum on drugs that can be impacted with immune therapy treatments and how to make them safer. And in the targeted treatments, if you would have asked me a few years ago, I thought that the targeted therapy treatment and oncology or the precision oncology space had plateaued because we…
I started to feel like we found the low hanging fruit. We made whatever progress we’re going to make. But we’re noticing now in the last three years specifically that there is so much potential to improve the delivery of treatments for the biomarkers that we’ve already discovered. Just to give you an example, we’ve known for decades that people with breast cancer who have a mutation,
who have expression of a protein called HER2 -neu are sensitive to treatments like Trastizumab. And you have to be positive to a certain degree. Your cancer has to show that it has that specific marker for that drug to bind and then be effective. So it was an option for a segment of breast cancer patients. But as these molecules have continued to evolve, and we’re seeing the development of what are known as antibody drug conjugates,
we’re noticing that you actually need a lesser and lesser expression of that molecule. So much wider spectrum of people are eligible for that treatment and can derive benefit from it. So it just, it continues to be an exciting space with a lot of evolution and a lot of innovation when it comes to cancer treatments. And it’s a great time to be involved in this field.
Daniel Ghinn
Amazing. So what are the kind of biggest challenges facing oncology treatment and particularly the GI and pancreatic cancer treatment area? I guess in terms of not necessarily only the development of new medicines, but you know, maybe there are other systemic issues. What are the challenges? I suppose, from a you’re in the US in Texas, you know, from a local regional national perspective, but perhaps globally, you know, what are the challenges that you see?
Shaalan Beg
If you ask me, I think the challenge are two. How do we allow as many people to have access to the novel and innovative clinical trials that are being developed? Because for a lot of people that may be the only way they have access to those treatments is through those regimens. And the second part is how do you keep up with…
the unprecedented number of new medications that are entering into the clinic. Each medication is coming in with its own sort of target population. It’s coming in with new type of side effects that physicians need to be aware of. And if you’ve been out of training for more than five or 10 years, this was not part of the curriculum. And we need to rethink how do we train
Daniel Ghinn
Right.
Wow.
Shaalan Beg
physicians to start oncologists to use these treatments in a safe and effective manner. So both of those require us to rethink the entire engagement process for trainees as well as practicing physicians.
Daniel Ghinn
-huh.
Wow, let’s take that. I want to come back to the question of access shortly, because I think that’s a really interesting one. But thinking about that, the advancement of knowledge, the new things, there’s that kind of counterplay, I suppose, between, or that tension between, we want to advance science, we want to find new treatments, and so on. But that constantly leads to this bombardment of new knowledge, not bombardment, but this awe of new knowledge. And how do physicians really keep up with that? What?
What do you think is the, what needs to happen to just to address that? How do we, how do we fix that?
Shaalan Beg
If we think about how that knowledge is disseminated right now, in a couple of weeks, there are going to be 40 ,000 oncologists who are going to get together in Chicago and have our largest annual oncology meeting. There will be dozens of parallel sessions ongoing where the results of these trials will be disseminated. Like, it’s physically impossible to attend the sessions that are happening at the same time.
And there will be data that is presented there that will influence the care of people the following Monday after the meeting. There will be other discoveries that are a couple of months or a couple of years away from implementation. Not everybody can make it to that conference. Not everyone who’s present at the conference can even digest the content that is being delivered. And then…
Daniel Ghinn
wow.
Mm -hmm.
You’re turning up for
a massive fire hose, right?
Shaalan Beg
Yeah, exactly. And then even when you think about the more conventional ways of releasing clinical trial data through journal publications and press releases, it’s hard to keep up with that. If I were to want to find the results of a specific clinical trial, there will be many trials in that space. And it can take me 15, 20 minutes to nail down the article that I’m really looking for.
So you have other support systems that are online textbooks that are available, which synthesize data and make it as practical as possible. You have guidelines that some professional organizations are developing that take away a lot of the guesswork and present it to you on if you’re in a specific treatment scenario for one of your patients, this is what the guidelines say, and then you can click the reference and take it. So there are different ways to…
consume that information both synchronously with the clinical care that we deliver and asynchronously with the clinical care that we deliver. And there are a lot of folks who are thinking about how we can use artificial intelligence and machine learning tools for our electronic medical records to sense what’s happening with an individual patient, what their stage or diagnosis, how they’re doing based on the note and other structured data.
Daniel Ghinn
Mm -hmm.
Shaalan Beg
and come up with decision support at the point of care. So there’s a lot that’s happening there, but we’re really still flipping through journal articles quite frequently and listening to conferences. And social media is making some of that consumption different. I think professional organizations and journals are waking up to the fact that…
Daniel Ghinn
Right.
Shaalan Beg
They only have two to three seconds to capture the consumer physician’s attention and they need to deliver information as effectively as possible. So they’re all, everyone’s in the process of continuously reevaluating their current modalities and see how they can be delivering that information more effectively and make it searchable and handy as well.
Daniel Ghinn
Right. Yeah. Yeah.
So, so you’re talking about a range of things from very sort of fast moving communicators channels to still the traditional journals flicking through those. So it’s safe to say the traditional journal, the traditional medical Congress meeting is not dead yet.
Shaalan Beg
Well, during COVID, we were all questioning whether we would ever come back and with the power, with the strength that we thought it would be that we would have and, and lo and behold, we are back to the way things were before for better mostly, I would say. And the Congresses and these conferences provide a, an
Daniel Ghinn
All right, yeah.
Shaalan Beg
and a platform or an avenue for people to meet one another and exchange ideas. I don’t think that anyone has been able to replicate that benefit virtually. A dirty little secret is a lot of people will go to the town where the conference is happening, listen to the sessions that’s being live streamed from their hotel rooms, and step out of the hotel rooms to meet.
people and to hang out at the receptions and the dinners because to me that tells us why we’re really there. There is little difference whether you’re present in the room where the speaker is or you’re watching it. But to have thousands of your peers, your mentors, people you look up to, people who are seeking you out, collaborators from industry, collaborators from academia coming together and then the federal government coming together, internationally coming together.
Daniel Ghinn
Wow.
Yeah.
Shaalan Beg
is an extremely valuable circumstance. And we’re noticing these professional organizations continue to reevaluate what their attendees are looking for. So if we take the example of our oncology conference, it became apparent to them that this interaction is why people were coming together. And the last couple of years, they redesigned the floors.
to have more lounge space and more plug -in for chargers and more neutral spaces for people to interact. So it’s very interesting to see how the conferences are continually evaluating to make sure they stay relevant and they stay up to speed with what the demands of their constituents are.
Daniel Ghinn
Mmm.
Brilliant.
Amazing. You talked to a few minutes ago about the potential or actual realization potentially of artificial intelligence for, to support decision making among, you know, so much new information. There are people listening to this who might feel perhaps a bit fearful about AI being used in medical, to support medical decisions. What would you say to them?
Shaalan Beg
I think it’s good to be skeptical. I don’t think it’s fair to be fearful. It is a tool just like there have been many tools before this, before AI. And we, to some extent, I feel if there are some decisions that can ensure quality of care delivery and they can be automated, they should be automated.
Daniel Ghinn
Yeah.
Shaalan Beg
For us to say that the clinicians judgment is always the best judgment, the best decision that could be made all the time is a little delusional. There are many factors that go into play, knowledge, mindset, just time availability.
Daniel Ghinn
Mmm.
Shaalan Beg
that these tools can really augment the clinical care that a physician is delivering. Do I imagine clinical care completely being automated where people interact with chat bots and emergency departments? Well, maybe for some problems that’s even possible, but by and large, these are tools to help make the care that a physician is giving be more consistent, to be better.
Daniel Ghinn
Yeah,
Shaalan Beg
and
Daniel Ghinn
right.
Shaalan Beg
to be more efficient and that I’m only excited about and optimistic for.
Daniel Ghinn
So ultimately you are talking about better patient care.
Shaalan Beg
Absolutely.
Daniel Ghinn
and potentially better outcomes.
Shaalan Beg
remains to be seen. I think we will notice a different set of problems that will emerge as these tools start being used in mainstream. As mainstream, we may see overutilization of some resources, we may see underutilization of others for better and for worse in either case. And there are efforts to establish standards and guidances on these tools.
Daniel Ghinn
Mm -hmm.
Shaalan Beg
I don’t think anyone knows what that’s going to look like. You probably saw the new releases of a couple of these large language models just in the last one week that were delivered. And at least for me, my understanding of what’s possible has already changed. So…
Daniel Ghinn
Yes. Yeah.
Yes.
Shaalan Beg
I think we have to be careful. There should always be the opportunity for clinicians to be clinicians because I don’t see these tools replacing that. And if there is a mindset that that can happen, I think we should study that very carefully.
Daniel Ghinn
Mmm. Mmm.
Yeah, absolutely. Can I come back to the question of access and one of the challenges you talked about in the oncology space and with new advancements happening and so on, You talked about you know, one of the challenges being that, you know, making sure that there is, you didn’t use the word health equity, but it’s what I’m kind of hearing there is that sense of equity of access to new treatments. What is it, Can you tell us a bit more about what’s the challenge there as you see it?
Shaalan Beg
Well, the challenge is that less than 5 % of people with cancer are treated on a cancer clinical trial. While at the same time, there are hundreds of cancer clinical trials that are running behind because they can’t find patients, which are causing delays in the development of these drugs and completion of these trials. And it’s also leading to lack of access for novel treatments from the patient’s perspective. So…
The reason is that most of the clinical trials that are available in the United States are in large cancer programs that tend to be urban, tend to serve better insured individuals, and are in mostly academic centers. Most of the patients with cancer are taken care of in the community. People want to see doctors who are within 10 minutes of where they live, or 20 minutes of where they live. So,
That is one big challenge for cancer clinical trials. And that does lead to inequities. And the inequities also is a double edged sword because what happens when you have inequitable access to cancer care, the people who are enrolling on the clinical trials may not look like the people who have the disease.
And on the flip side, you are preventing in some circumstances folks from having access to these novel treatments. And in the space of precision oncology, this is very very well established that for probably about a year or two years between when the investigators know that this compound is active in a drug to the time a patient.
Daniel Ghinn
Right.
Shaalan Beg
have access to it across the space. I had a patient who had a mutation in her cancer that we identified in Dallas. I found out about a trial for that mutation that was open in Houston. I found that out because the PI posted something on social media and I messaged that doctor from social media to say, hey, you still taking people for this trial and –
Daniel Ghinn
huh.
Shaalan Beg
I sent my patient and they’ve been now on that trial for more than seven years. And that’s not scalable. That’s not a process which is equitable. That’s not good for the entire community.
Daniel Ghinn
Amazing.
Mm -hmm. Mm.
So it relied on that chance encounter with the social media content, the PI seeing it and so on. But let’s talk about social media. You’ve been using social media for a long time, actually. How important has social media been for you in your professional work?
Shaalan Beg
Absolutely tremendously important. I will say when I joined social media, I thought that I was joining social media with the purpose of engaging patients and people who have questions about cancer. Very quickly, I realized that at least when it came to Twitter, which is where I was spending most of my time,
my audience and the people who I was following were mostly other healthcare professionals. So that brought its own benefits of networking, learning from other experts in the space, being able to discuss challenging situations, learning from others’ experiences, and organizing, to be honest. There are a lot of groups that organized because we were able to find…
like-minded individuals who lived hundreds of miles away that we would never have been able to know or meet otherwise, where again, now we often would go to one of our oncology conferences and meet somebody physically for the first time, but we know them very well because we know the way they talk and with how they think, and we’ve had potentially dozens of interactions before we ever meet them physically. So that’s been an extremely rewarding experience for me.
Daniel Ghinn
Hmm.
Right. Yeah.
Yes.
Shaalan Beg
I find, at least the way I use it for myself, social media to not feel like work. It doesn’t feel like email. It doesn’t feel like something you have to do or checkbox. I know for some people it can. And we’ve been able to organize and with time develop a library of conversations around pancreatic cancer specifically.
for people to go back and archive and look at discussions on certain topics where we have not only been able to capture the thoughts of other physicians, surgeons, medical oncologists, but also opinions from nonprofits and advocacy organizations and link it to resources that patients can then take back. And I have heard directly from people who have followed me that it was a result of…
Daniel Ghinn
Hmm.
Shaalan Beg
passively seeing these conversations that led them to reevaluate their family history and then get genetic testing and have test done. So that’s just one example, which means a lot to me.
Daniel Ghinn
Wow.
Amazing. So that’s a really
powerful way that you can actually make an impact through social media. So you’re learning, you’ve got the community, you’re also disseminating information out to others.
Shaalan Beg
Absolutely.
Daniel Ghinn
What advice would you give to other physicians or other healthcare professionals who are looking to grow both their knowledge and their impact online on social media?
Shaalan Beg
Physicians have to be present in social media, on social media platforms. Whether that is an image -based social media platform, I don’t know what the correct phrase is for platforms like Instagram, or short video platforms or short messaging platforms, now they’re all kind of merging into one anyways, that I think is up to whoever and whatever one’s strengths, weaknesses, or their…
Daniel Ghinn
Mm -mm -mm.
Hmm.
Shaalan Beg
personalities
are, but we have to be present. We saw over the last five years that if there is a vacuum in these spaces, that vacuum will be filled by somebody and somebody’s voice. And we would rather that those voices be ours, given our expertise in certain areas and rather than what would be, you know,
Daniel Ghinn
Right.
Hmm.
Shaalan Beg
generally be labeled as disinformation. And that can have far reaching consequences. It can have consequences on public health. It can have consequences on professional growth. So I think oncologists, physicians need to be present on social media. We need to know what other people are thinking. We need to have an avenue to share our thoughts. Patients are watching and they may not be engaging, but you know, they…
Daniel Ghinn
Hmm.
Shaalan Beg
they do look and if you have an online persona or online reputation, it impacts how our physicians view us when they come see us. They already know some of the things that we’re going to talk about and it drives more confidence in them. I do feel that physicians are increasingly being engaged, are increasingly getting engaged in the short video.
Daniel Ghinn
Mm.
Shaalan Beg
format and I think that is extremely compelling. It’s, you know, the next generation, the people who are in medical school and into their training right now, they do not want, I’m sure they do not want to sit through 90 minutes of a lecture when, you know, they, when we all know exactly what those tidbits need to be, bite -sized tidbits need to be in order to help drive their care and we, it’s our responsibility to deliver that to
Daniel Ghinn
-huh.
Mm -hmm.
Hmm.
Shaalan Beg
other
professionals and our advocacy and patient groups as well.
Daniel Ghinn
Where do you see that being done well at the moment? That kind of short video? Who’s really, you know, who’s doing that well?
Shaalan Beg
I mean, there are a lot of influencers, I guess I can call them in the oncology space. Eleonora Toplinski, Dr. Eleonora Toplinski on Instagram and TikTok, Dr. Don Dijon on Instagram and TikTok. I think they have over the years created tremendous followings where as new studies come out, they’re able to give their…
interpretations about on it. And I can give you an example. There was a discussion in my home on the health effects of manicures for for for for what are the complications? I don’t know anything about what what what what the complications could be or what the data is. And and Dr. Blinsky, there was an article that had come out. Dr. Blinsky had done a review specifically on that right right at the time.
Shaalan Beg
There was a conversation going on in my household about it. So, you know, I can imagine how often that happens with other individuals as well who are health conscious, but even those who are not. I just want to passively learn more information.
Daniel Ghinn
Amazing.
Hmm.
Wow. If you were, if you were starting over now in building your sort of online impact, what would you do differently?
Shaalan Beg
One of the things that I have become a little more aware of and a little disappointed with is the realization that if we build our persona on a platform, we are really beholden to that platform. So for example, when one social media got acquired and changed its name and I was asking for subscription effects, it completely changed the dynamics of…
how people engage with that content, who was present on those platforms. And right now with different platforms having different perspectives in terms of what they stand for, what their mission really is, it’s becoming harder for me to think about one platform which is for the general population.
Daniel Ghinn
Mm -hmm.
Shaalan Beg
number
one and number two.
we have seen in healthcare and outside of healthcare that by relying on these platforms for our to create our following, if something happens to the platform or if you become persona non grata on that platform, all of that can go away, which for professionals who are engaging on social media,
Daniel Ghinn
Hmm.
Shaalan Beg
isn’t as big of a deal, but for people where that is a much larger section of their engagement process and their business model, it really can impact those bits. So I am curious on what the next couple of years would look like. If I take the example of Dr. Eric Topol, who’s a cardiologist, the Scripps Cancer Research in California.
Daniel Ghinn
Hmm.
Shaalan Beg
He has set up his own email list for, or a sub stack list for engaging with his audience with the, and then he owns the audience. He can take it with him if he wants to transition to a different platform. And I would imagine that more physicians will start taking that route, but it does require creation of new skill sets, which not everyone has or has the time to develop.
Daniel Ghinn
Hmm.
Right? Yeah.
Wow,
amazing. It’s going to be an exciting time to watch where it develops as the platforms develop over the next couple of years. I look forward to watching and continuing to listen to you. Now, if people do want to listen in to you, what you’re sharing on social media, et cetera, where’s the best place for people to find you online?
Shaalan Beg
For right now, it’s on X. First name, last name is my handle. So S -H -A -A -L -A -N -B -E -G, Shalan Big. I have a TikTok channel, ShalanBigMD. I need to put some more effort in it. Hopefully I’ll be able to delve that some more and kind of cross post on that and Instagram. Yeah, so really excited to continue the conversation. Thank you.
Daniel Ghinn
Fantastic. All right, look forward to watching that develop. Dr.
Begg, thank you so much for taking the time to talk to us today.
Shaalan Beg
Thank you for having me.
