Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
What You Need to Know About Lung Health Could Save Your Life
A fascinating journey into the world of pulmonary medicine awaits as Dr. Neil Ettinger shares his expertise on the complexities of lung health and disease. With decades of experience as a pulmonologist and researcher, Dr. Ettinger offers valuable insights that could quite literally help you breathe easier.
We dive deep into interstitial lung disease, a condition affecting many older adults where the lungs develop progressive scarring that compromises their ability to function. Dr. Ettinger explains the difference between known causes like autoimmune disorders and occupational exposures versus idiopathic cases where the trigger remains mysterious. His optimism shines through as he discusses recent breakthroughs in treatment options, including two approved medications and a promising new drug that recently succeeded in clinical trials.
The conversation takes a crucial turn toward lung cancer screening, revealing the shocking statistic that only about 6% of eligible Americans participate in these potentially life-saving screenings. Dr. Ettinger outlines who qualifies for the annual low-dose CT scans and why catching lung cancer early makes such a dramatic difference in treatment options and outcomes. For those concerned about lung nodules found on scans, his explanation of benign nodules common in the Midwest provides reassurance about what might be normal findings versus cause for concern.
The future of pulmonary medicine looks increasingly promising as we explore emerging technologies and treatment approaches. From targeted cancer therapies that cause fewer side effects to robotic bronchoscopy systems that navigate the complex airways for precise diagnosis, medicine continues to advance. Dr. Ettinger even touches on how artificial intelligence may soon transform how we detect and diagnose lung conditions, potentially saving countless lives through earlier intervention.
Whether you're concerned about your own lung health, caring for someone with respiratory issues, or simply curious about this vital organ system, this episode offers valuable perspective from the frontlines of pulmonary care. Listen now to gain insights that could help you make better-informed decisions about monitoring and maintaining your respiratory health.
Welcome to Doc Discussions. This is Jason Edwards, and I'm here with my good friend, dr Neil Ettinger. Neil, how are you doing today? I'm doing well, jason, good to see you. Sir Neil, you're a pulmonologist, is that correct? That's correct, and so tell me a little bit about yourself. Where are you from originally?
Speaker 2:I grew up in Miami Florida, Really yeah.
Speaker 1:I've known you for a while I never knew that.
Speaker 2:Yeah, you never asked me. Yeah, so Miami is an interesting place it was far more interesting in, you know, the 1960s and 70s, when it was a new city and it was just being born you know, but it's gotten pretty busy and pretty different than when I grew up there.
Speaker 1:Yeah, I was there a few years ago. One of the things I recognize it was a third Hispanic, a third African-American and about a third Caucasian or white Is the demographics. Have they changed over the years?
Speaker 2:I don't know if that's true or not. I mean, I think it used to be half, you know, white, half Hispanic, you know, with a small sliver of African-American in there, but it may have changed over the years.
Speaker 1:For sure, yeah, mostly Cuban, right, right, yeah, and so, yeah, great city for sure, and so, and then, where did you go for undergrad?
Speaker 2:from Miami, I went to Vanderbilt University, very good. So I was there from 75 through 79. So you were a Commodore. Huh, I was a Commodore, you know, but it took a while to adapt to the idea that I was in that deepest South, you know place Cause Miami was never felt deep South, sure, but Vanderbilt certainly did yeah, miami, it feels like an international city.
Speaker 1:It does, yeah, it does. And then um, and then from Vanderbilt, washu med school Very good, very good, and then you stayed there for residency as well.
Speaker 2:Stay there for residency and then I took a year off and went to England for a year studied, did some critical care at MoBAP for six months and then six months in London, england, where I did some research on bone marrow transplant patients with lung complications.
Speaker 1:How about that yeah?
Speaker 2:And which? Hospital was that the Royal Marsden Hospital in London and then the Brompton Chest Hospital in London.
Speaker 1:Yeah, and was their health care system? Was it different than ours?
Speaker 2:Much different, you know, and it's still the same today. I mean, it's a national health system, so long waiting list for elective procedures.
Speaker 1:Yeah, and you may know this, chris Cronin's grandfather wrote a book, jack Cronin, and they say that that is kind of the impetus for starting the NHS. Oh, really like how their healthcare system just wasn't working well, um and uh, and it kind of became a bestseller, uh, and then he wrote multiple movie scripts after that.
Speaker 2:Well, in England they have the Harley street doctors, which are the equivalent to private practice doctors. If you can afford them or have insurance for that, Okay. Otherwise everybody is in the national health system and I don't think that's changed any.
Speaker 1:Okay, yeah, and there's some pluses and minuses to the socialized health care for sure, and that's a topic for a whole other deal. So now pulmonary. So after you do your internal medicine residency, then you do a palm care residency or fellowship.
Speaker 2:So at the time critical care was not its own specialty. I'm that old, I'm that old, so it was pulmonary. And then you came out with your certificate in pulmonary and critical care. Later on, critical care became its own specialty. So you don't automatically get pulmonary and critical care these days. These days you need to do two separate fellowships or an extra year in your pulmonary fellowship for critical care.
Speaker 1:Okay, I always thought it was the same thing wrapped up in, but it's their two separate specialties. Now they are Okay, that makes sense.
Speaker 2:I mean you can get certified in pulmonary and critical care with the extra dedicated year to critical care.
Speaker 1:Yeah, and it makes sense that they would go hand in hand, obviously because a lot of the patients are on ventilators and things like that.
Speaker 2:Right. So when I was in training you know in the 83 to 86 was my medicine residency I took that year off in 87. So 87 through 89, at that time critical care started to become its own specialty and you know, intensive care units started to take off as dedicated facilities. So critical care didn't always have the kind of sense of an ICU that we know today. You know it kind of that evolved too.
Speaker 1:Yeah, and you have some are open ICUs and some are closed. That's correct.
Speaker 2:Yeah.
Speaker 1:And so, but I think the trend is moving more towards a closed ICU that's just managed by an intensivist.
Speaker 2:The intensivist correct yeah.
Speaker 1:Which seems like a good way to go.
Speaker 2:Maybe, maybe it depends on where you're at. It depends on you know. There is a role for specialists, of course, in a closed ICU. So, as long as the patients get the best care and there's interchange of ideas, it's that interchange of ideas that makes a difference between a spectacular ICU and the average ICU. You know where when you have difficult cases you have. You know people with different, you know approaches to treatment and diagnosis. You know all of them cooperating, collaborating on the same patient.
Speaker 1:Yeah, I would think any ICU should have a strong relationship with their pulmonologist, whether they're managing, you know quote unquote managing the patient.
Speaker 2:And I think for the most part we do. I think you know. What we don't need to do is duplicate services.
Speaker 1:Yeah, yeah, and especially these days with. You know most hospitals operate on a very tight margin. You know we need to be efficient, but maximally effective as well, and so and so now, so in your practice, of course, you and I interact a fair amount with patients who have lung cancer. Correct, what percentage of your practice is you and I interact a fair amount with patients who have lung cancer? What percentage of your practice is, you know, malignancy versus non-malignant palm issues?
Speaker 2:So you know, I would say malignancy is probably 10 to 15% of my practice. A lot of the rest of it is chronic interstitial lung disease, since that's an area that I've specialized in and so I see a lot of patients with interstitial lung disease and we're a pulmonary fibrosis foundation care center here so we are kind of known for our expertise in that. So I spend maybe half my time. We have a clinical research unit called the Lung Research Center. That's connected to our practice, you know, physically, and we see we put a lot of patients in clinical trials for new drugs for treatment of interstitial lung disease.
Speaker 1:What causes interstitial lung disease?
Speaker 2:Well, there's the group of interstitial lung diseases, of known causes, and then the unknown causes, and so the known causes might be autoimmune disorders or occupational lung exposures, you know, drug-induced lung disease, you know whereas the unknowns might be, the most common being idiopathic pulmonary fibrosis. The idiopathic means we don't know what causes it, but the idiopathic, you know, is probably the largest group, and so, for most people, we don't know what triggers the development of pulmonary fibrosis. What we do know is it's a disease of aging. You don't see this in people who are in their 40s or 30s, you know. You see this in people who are in their 60s and 70s and 80s.
Speaker 1:What do they think causes it? Are there any contenders or hypothesis?
Speaker 2:Well, some injury occurs, you know, at the cellular level that elicits an abnormal response of wound healing. So instead of healing completely, so that it's indistinguishable, you know, you have this constant drive to form more scar tissue. Okay, sort of like if you, you know, are a keloid former and you cut yourself, you know ordinary non-keloid former people would heal.
Speaker 1:Yeah.
Speaker 2:And you might not even be able to see the cut down the road. You know, but in keloid formers you get heaped up scar tissue that develops. Yeah so what triggers that exuberant development of scar tissue? Well, you see that in the lung, you know, in a patchwork type quilt inside the, in the lung tissue, where you got normal areas of lung next to scarred up areas of lung, you know I actually I treat patients who have keloids after surgery.
Speaker 1:It's and of course with the keloid it's an overactivity of the fibroblast, and mostly in African-Americans, but not exclusively, and then you can have excess scar tissue formation on the palm, which is Dupuytren's contracture and a similar process, and then in the penis you can have it which causes Peyronie's disease, but it's probably, I would assume, in the lung. It's probably a little bit more complex than those processes.
Speaker 2:It's more microscopic, yeah, probably a little bit more complex than those processes and it's more microscopic, you know, and it's hurt, but the lung ultimately becomes, you know, stiff and small and incapable of exchanging gas. Yeah, you can't get, you know, oxygen into the system and you can't get carbon dioxide out at the end of it.
Speaker 1:You know, when all is said and done, at the end, yeah, yeah, that delicate tissue that exchanges the oxygen to the blood needs to be thin, and if it has scar tissue it's just not going to exactly. Yeah, that that's that's interesting. Um the um. I recently bought this device that I put in my house that measures particulate matter. It has like particulate matter 2.5, five and 10. I think it's microns, but I'm not sure. And then it measures like um. It measures like HCHO, which is formaldehyde.
Speaker 2:You want me to come over and help you clean out your ducts.
Speaker 1:Well, it actually turned out to be pretty good. The one thing that was high was formaldehyde oh really, and they think that can come from furniture and things like that. So I had to get this filter. It's got like 26 pounds of carbon in it, a special type of carbon to like filter it down.
Speaker 2:Filter the whole house. Air conditioning yeah.
Speaker 1:And so. But it just made me kind of cognizant that like you've got to kind of be paying attention to what you're breathing.
Speaker 2:It sounds expensive.
Speaker 1:Yeah, it wasn't cheap, but if I'm breathing every day, I feel like I should. There's dumber things to spend your money on.
Speaker 2:So we're much safer here in the hospital. I take it.
Speaker 1:Yeah, I think an older building probably just has cleaner indoor air because the off-gassing of things whether it's the materials used to make a house or the carpet, is less because they've kind of off-gassing of things, you know, whether it's the materials used to make a house or the carpet you know is less because they've kind of off-gassed over time. And then you know, of course, outdoors is typically the air is a lot cleaner than indoors. Yeah, I think that's right. Does that sound right? Don't know. Yeah, yeah, I guess it depends on where you're at Um the um. To me it seems like St Louis is um very high in allergens. Um, because the flora and fauna. Does that play into your practice? People have allergens and asthma.
Speaker 2:It does. Um, a lot of allergists see the easy to treat out asthmatics and the more difficult ones, but um, it seems the pulmonologist doesn't see the asthmatics quite as much, unless the way the patient is presenting is misleading and you finally figure out that what they actually have is asthma.
Speaker 1:Got you.
Speaker 2:You know so, but you know I think the Midwest, and in the Midwest St Louis is probably at the top of the list for allergy, for difficult allergy cities yeah and um, I think it's always been that way is that a function of our rivers meeting here and there's a lot of different flora and fauna? Don't know don't know, but I suspect that it does have to do with the plants that are found here and the temperature here and what's. You know what spores can live here in the soil and that sort of thing and?
Speaker 1:And speaking of things in the soil, you and I look at a lot of CT scans and see a lot of benign nodules Right, and it seems like this is kind of fertile ground for benign nodules in the lung.
Speaker 2:Is that the fungus that causes that, or Well, as you know, histoplasmosis kind of lives in the soil here. And it doesn't take much disturbance of the earth to get the spores. You know circulating and it is easy to inhale. And you know when you inhale histo you know the body reacts to it. You know it turns on its reaction and kills it where it sits. And the nodule is the evidence of the battle.
Speaker 1:Yeah.
Speaker 2:And it may go on to calcify. Typically, it will go on to calcify, which is a good sign.
Speaker 1:You'd rather see a calcified nodule.
Speaker 2:I don't think you've radiated too many calcified nodules.
Speaker 1:I don't think so and they don't do much. If you do, I would presume. I see patients who have ocular melanoma and a lot of times we'll get the staging scans for them and I always try to kind of give them a heads up. You know, plenty of people will have nodules in their lungs in St Louis that are not cancer, right, and so, and, and you know, now patients can read their CT scan results before you could talk to them, and that's an issue. It is a big issue, right, and it causes a ton of anxiety and it's a I think it's a federal law now it is, and so I think it's probably, in my opinion, done more harm than good. Do you have any thoughts on that?
Speaker 2:I mean, I think in some ways it does take the pressure off that the patient can be just as informed as you are. For sure, I think. While I don't mind them seeing results and dealing with the anxiety that produces, because that's a choice that they've made, at least they have the option to make that choice. Yeah, I think what I do mind is they're being able to read notes that might have very candid comments, because you're trying to be accurate and communicate to all the other doctors and I think sometimes patients may find the ability to read their own notes disturbing, you know, or upsetting.
Speaker 1:Yeah, yeah for sure, and there's no doubt about it, it's going to modify the behavior of the doctor. Modify the behavior of the doctor. Like to give the listener an example. If somebody is very obese, that can play into their breathing, it can play into a lot of different health issues. But I'm probably going to be less inclined to say a patient is very obese in their note, if I know they're reading their note, you know and it's, and maybe that's bad on me, but but or I'm just saying the doctor, the generic doctor, would be less inclined to say something that's true, but maybe reflects poorly on the patient and is Well a good example for for me, would be somebody who complains of shortness of breath and you've done a complete workup and they're in the end you suspect it may be due to obesity or deconditioning, or it may be related to anxiety or stress.
Speaker 2:But you cannot reach that conclusion without having done the work to be sure it's not the heart or not the lungs. Um, people don't sometimes feel dismissed when they're they're asked about anxiety or stress or depression, but it's a necessary question when you have symptoms of shortness of breath that aren't obviously explained by something else. Yeah, because it is a true, bona fide cause of of these symptoms. No, no, no doubt about it. Same thing with obesity and deconditioning. You know it is sometimes difficult to say well, you know you're overweight, you're out of shape, you're deconditioned and the heart's good, the lungs are good, everything we've checked is good. But sometimes people feel dismissed by that. You know, by reaching that conclusion. So reading it in the absence of being able to discuss it at that moment with the doctor can be, I think, hard to handle sometimes.
Speaker 1:Yeah, and kind of in both situations there's a lack of context and nuance that you could in a face-to-face conversation you can see somebody's not trying to hurt your feelings, they're just trying to be as honest and as accurate as possible. And yeah, yeah for sure. So it's made medicine and the practice of medicine, which is already complex, kind of more complex. True, and so a lot of the patients that I end up seeing ultimately for lung cancer have gone through our lung screening CT program and, and I think we do a really good job of that Lola Brand is awesome.
Speaker 1:One of our nurses who helps with that and there's some pluses and minuses of every screening program. You can have some false positives and can you talk a little bit about the screening program and kind of what patients qualify for that?
Speaker 2:Well, patients from like age 55 through 77 qualify. If they have stopped, they can still be smokers. If they've quit smoking, it can't be for more than 15 years and if they've smoked up to I guess, 20 or 30 pack years I can't remember the precise criteria there and if they meet those criterias they can then enter into an annual low-dose CAT scan screening program. And low-dose radiation is what we're talking about. And because by the time you see an abnormality on a chest X-ray, most of the time that may be more than a stage 1 cancer. Yeah, and you know, metastases are common when you're waiting to see something pop up on a film. So chest X-rays have never really saved any lives, but CAT scans have been shown to save a significant number of lives by finding cancers when they're more treatable. When you're annually screening somebody, you have a very good chance of getting something when it's an early stage cancer.
Speaker 1:And you know lung cancer more than you know other more common cancers like breast, prostate and even colon cancer. It can really go from stage one to stage four pretty quickly. It does, and the outcomes difference between a stage one and a stage four cancer are just night and day, and so it's not surprising I think that the survival benefit that came from this trial was stronger than the other screening programs, and it's kind of not surprising for that reason. But it's the minority of people who actually would qualify for it who actually get screened. Is that right?
Speaker 2:Say that again the minority of people.
Speaker 1:The minority. So the amount of people out there who are eligible to undergo screening for lung cancer, you know, is much larger than those that actually get screened. Yeah, yeah, it's just very few.
Speaker 2:Well, it helps. That's why it's helpful to have a coherent program.
Speaker 1:Yeah.
Speaker 2:But recognizing that the patient, the new patient that you're seeing in front of you, who has an internist and a you know endocrinologist and a rheumatologist, and you know who's going to remember to order the lung cancer screening. It's nothing is made automatic. Somebody has to remember to order it Once you're in a program and most centers and hospitals have a program rather than just randomly offer a CAT scan. Or, in hospitals, have a program rather than just randomly offer a CAT scan but once you are in a program, then annually someone's going to be reaching out to you or notice that you didn't show up or didn't have a screen.
Speaker 1:Yeah.
Speaker 2:And so I think having a real bona fide program is key. No doubt about it, because all those people that are not being reached are sometimes falling through the cracks in their own physician's office and in their pulmonologist's office.
Speaker 1:Yeah, and I feel very fortunate to have a great program here. The number I have is that only about 6% of eligible US adults get screened, which is just you know.
Speaker 2:Think of how many lives we could save. It leaves a lot of room for improvement.
Speaker 1:It was 80 or 90%? Oh yeah, for sure. And it's the newest screening program too. I mean mammograms and colonoscopies have been out and prostate PSA checks have been out there for a long time and the lung cancer screening is relatively new. I think it was maybe 2010 or something like that that the trial was actually published. But I think you know, if we're looking to save lives, that's certainly an area of opportunity and if a listener's interested, you can call St Luke's and get right into the program.
Speaker 1:Usually, if you meet the criteria, it's not an issue at all and it's very well run and we've saved a lot of lives through our hospital with these patients. If it's a stage one lung cancer, the patients are typically seen by Ryan Reedy or Jeremy Leidenfrost and they have a lobectomy or a wedge resection or seen by me, and we treat them with a short course of radiation. Lobectomy or a wedge resection or seen by me, and we treat them with a short course of radiation. So of course, the majority of patients who have lung cancer it comes from tobacco cigarette use, but there are some patients who do have a lung cancer that's not from smoking. Is that right? That is correct, and do they know what causes that?
Speaker 2:Well, you know there may be. You know other things like radon gas in a household yeah, you know it might be. You know chemicals in the home environment or in the food supply, you know. So there's lots of angles by which you know people can develop lung cancer. You know across the world it's. You know indoor cooking lung cancer, you know in across the world it's. You know indoor cooking, you know with. You know when you have your burning charcoal or your burning wood. You know to cook and to eat. You know people get lung cancers and emphysema from those exposures.
Speaker 1:Yeah.
Speaker 2:You know. So, yeah, there's, you know, absolutely you know, a role for non-cigarette, non-tobacco causes of lung cancer, although you know tobacco is the first thing we think of when we think of lung cancer.
Speaker 1:Yeah, if I recall it was like 95% are from cigarettes. Now, sometimes, and especially in Missouri, radon is a real issue and that's why if you get by a house, you have to, you know, see if you need a mitigation system in your basement. It's. And we actually use radium to treat cancer. You know radium 226 and radium 223. And radon is just an off product of that and so it can. It's, you know, it's radioactive.
Speaker 1:Right. So it's a big deal. And then sometimes when patients especially if they're a nonsmoker have a lung cancer, they have what they call a driver mutation, as you know, and there's some targeted chemotherapy.
Speaker 2:That's just a pill that you take and patients can do really well, even if they have metastatic cancer, and so um, so what you're saying is that the that in non-smokers who get lung cancer, they may be more amenable to some of the new targeted therapies that we have yeah, absolutely that many smoking related lung cancer patients are not um they they not benefit.
Speaker 1:Yeah, it just kind of happens, you know, to be like that, and so the outcome of somebody who's a non-smoker with a lung cancer compared to a smoker is better, and it's the same with head and neck cancers too for a different reason, but it's because those are driven typically by HPV and not smoking.
Speaker 2:Do you foresee the demise of standard chemotherapy at some point?
Speaker 1:I think that it will be utilized less, but I think we will always use it to some capacity. But the targeted therapy and the immune therapies have really made a lot of headway. And then now you have the emergence of CAR T-cell therapy, which is kind of just on the cusp, mainly used in lymphoma where you used the patient's own T cells to attack the cancer. So there's some exciting, you know totally new classes of drugs, you know in the pipeline and you know Mark Fessler here, right, super smart guy.
Speaker 2:And super exciting work.
Speaker 1:Who's doing some really great clinical trials. You know he's working with a lot of that and it's just totally cutting edge stuff and, to be you know, I'm somewhat familiar with it, but he can certainly speak about that much more intelligently than I can. So, but you know, so you can get to a point where those don't work anymore. You know the cancer outsmarts it because you've not only got to kill every cancer cell but there's different clones of cancer cells, and so you can kill the majority of them or keep the majority of them at bay for a while, but it's hard to take out everyone. You know if somebody has metastatic disease and so.
Speaker 1:But I do think that that's the trend will continue where we utilize those much more than the other medication. You know the old school chemotherapy drugs like cisplatin and Taxol and things like that, and the nice thing about that is the targeted therapies and the immunotherapies have much less side effects typically, you know, compared to the standard chemotherapies, although they've gotten a lot better at managing the side effects from the standard chemotherapies as well. And so, yeah, I think you know hearing about all this kind of stuff it's it's it's daunting, you know, especially with you know, when you're having breathing issues.
Speaker 1:Of course, anxiety and breathing issues go hand in hand If you come in, you can't breathe, you're going to be anxious, I promise and it's daunting thinking about this, but it's also coupled with some excitement looking into the future that hopefully, especially if they can use AI with research, you know they can accelerate of treatment strategies can change prognosis for pancreatic cancer, for glioblastoma, for some of the untouchable cancers that seem not to have a really good response to treatment, that are almost inevitably fatal.
Speaker 2:If we can change the conversation in those tumors, that would be awesome.
Speaker 1:Yeah, and you know something that I haven't seen a lot of but I think is, you know, maybe on the forefront too, is cancer metabolism. As far as, like, the things you can do as a person, is there an optimal diet that may work with an optimal therapy? I think there's a lot to be kind of learned in that and that's still pretty wide open. I mean, there's not a ton of recommendations, you know, on that kind of stuff. You know they thought does a keto diet help with?
Speaker 1:you know, um, and that's not, you know, ready for prime time yet, but you know that's another question that can be answered. Um, in fact I had a patient who was on. She was on on TPN for another reason, but she had a pretty bad lung cancer and we treated it and she kind of did surprisingly well for a long time and it just, you know, it's it's a one of one situation, so you don't know, but it's like she's on TPN, it's. Does that have something to do with it or not? I don't know, but it always just made me think, you know, is there something we can do? You know, on the other end, and hopefully with ai analysis of patient outcomes, you know, we can maybe detect some of these trends a little bit better. That would, kind of point, point us in the right way to generate a good hypothesis to test um well, ai is going to change things for everybody, including in lung, lung nodule detection.
Speaker 2:I'm sure you know that we will see a higher yield, you know, and um, and maybe even more accurate diagnosis with the use of AI.
Speaker 1:Yeah, yeah, I think there's plenty of room for excitement and it's something we should embrace, um and so, but you know it's something we should embrace, and so you know it's good to be skeptical. Good scientists should be skeptical, so we should embrace it with some skepticism but also embrace it, you know in aggregate as well. So are there any new things that you see on the horizon with pulmonary care, any new medications coming out?
Speaker 2:Well, we have in the field that I am active in in interstitial lung disease. We've had two drugs approved in 2014 that are almost identical in effectiveness both Ofev and Espriate and we have a new drug, naramandelast, which is a brand new antifibrotic drug that just met the criteria for success in the clinical trial, so we'll have a third drug now to start hopefully designing some combination treatment trials to get better results than we are Right now.
Speaker 2:we're adding two or three years to the people's lifespans and we're, you know, we are finding the disease you know still inevitably fatal you know. So we don't have a drug that will stop it, but we, hopefully, will have combinations of drugs that will stop progression.
Speaker 1:Yeah.
Speaker 2:You know we can slow it down, but we can't stop it yet.
Speaker 1:Well, it's exciting to see that we're making some headway in that we are, so we're getting better in the world.
Speaker 2:There's a lot of attention in clinical trials for, you know, finding drugs for pulmonary fibrosis, both the idiopathic versions of it as well as the autoimmune versions of fibrotic lung disease.
Speaker 1:Yeah.
Speaker 2:You know, so we are getting better at managing these patients.
Speaker 1:And, as you well know, I mean there's. The truth of the matter is there are many ways a person's life can come to an end, and some are much worse than others, and I would think kind of slowly suffocating would be a bad one, and so yeah, so that's exciting to see that we're maybe making some progress with some new drugs, and I'm sure there's many other drugs in the pipeline. Some of them will work out and some of them won't in the clinical trials, but hopefully we have an exciting future here in developing some new medications.
Speaker 2:And then there may be new delivery systems, delivering using interventional techniques. You know chemotherapy to nodules, you know. Whether we have the technology to ensure accuracy and to allow that kind of risk is still debatable, but that's something on the horizon that I think is a goal. Yeah, you know. So. I think you know we have robotics. You know now in interventional pulmonary Probably the yield is probably a little bit better, you know, than the navigation systems that we use now. But you know down the road whether we can actually use it both to diagnose and to treat. That's a really important question to answer.
Speaker 1:And you're talking about actually going down the throat through the trachea and getting to the lung nodule.
Speaker 2:That's correct and navigating to that nodule using either robotics, you know, or GPS for the lung, so to speak.
Speaker 1:Yeah, and it's tougher than you know. Probably most people would initially think, because you don't get to pick exactly where you go. You have to follow the windpipes.
Speaker 2:You have to be following the airway that you're given. Yeah, you know the ones that God made for you, and sometimes things may be behind a wall you know, and you, you know you have to still be able to deliver and to both diagnose and to treat.
Speaker 1:And then on top of that, the lung is. The whole lung is moving up and down and the nodules moving up and down. That's correct, and so it's. It's some fancy dancing to get there, Right.
Speaker 2:And it's usually an hour and a half procedure, whereas a typical bronchoscopy might be 20 minutes. So it does take a lot of time to to navigate to these, these lesions, yeah.
Speaker 1:And I think I may have told you this once before, but Don Busick once said this about you. He said if you really want to get a good biopsy and get a good piece of it, call Neil Ettinger. And so I thought that was a real compliment. Well, that was nice of Don to say that. Well, neil, thanks so much for not only joining me today, but all of the work that you do with our mutual patients and all the work that you're doing with interstitial lung disease and trying to prolong the length of patients' lives and improve the quality of their lives.
Speaker 2:Well, thank you, jason, and I do want to say that the same goes for you, because when we're making a diagnosis of lung cancer in somebody, to be able to pick up the phone and know that they're going to be treated with the care you provide them, the emotional support that you give them and the high-quality medicine that you practice with them, you know that really, you know, means a lot to those of us that work with you and take care of these patients.
Speaker 1:Oh, thank you, sir, I appreciate it.
Speaker 2:Thank you yeah.