Detecting Cancer Sooner: Dr. Joshua Routh on Liquid Biopsy & Epigenetics

WELCOME TO EPISODE 229

EPISODE TRANSCRIPT

0:00
What if a single drop of blood could detect cancer before it starts to grow?
And what if your doctor didn't even know that the test existed?
Today, we are diving into the future of early cancer detection with Doctor Joshua Ruth.
This is a groundbreaking blood test called Epiceek, and it's changing the game at spotting cancer signals before they appear.
0:22
We'll break down the science, who should consider it, and why patient autonomy and healthcare has never been more important.
And I've got a great gift for our listeners.
The team at Precision Epigenomics is offering an exclusive $50 discount to claim the offer.
0:37
Download the test from precision-epigenomics.com and have your doctor write Beautifully Broken at the top of the form by August 1st, 2025 to qualify.
Let's rethink healing, redefine resilience, and let's do it one episode at a time.
0:54
Let's go.
Welcome to the Beautifully Broken podcast.
I'm your host, Freddie Kimmel, and on the show we explore the survivor's journey, practitioners making a difference, and the therapeutic treatments and transformational technology that allow the body to heal itself.
1:13
Witness the inspiration we gain by navigating the human experience with grace, humility, and a healthy dose of mistakes.
Because part of being human is being beautifully broken.
Ladies and gentlemen, welcome to the Beautifully Broken podcast.
1:33
I am here with Joshua Ruth.
Doctor Ruth, how you doing today?
I'm good.
Thanks, Freddy.
How are you?
I'm excellent.
I'm excellent, excellent morning.
You know, I had AI had a night's sleep where I had AI.
Don't know if you've ever woken up in the middle of the night, and it's not like you can't sleep, but I'm filled with ideas and my brain is planning to, you know, make this incredible impact in the world.
1:55
And I was just so excited about life.
I couldn't sleep.
But I did my morning routine and I got to the gym and I honestly, I, I feel really good.
I'm really excited to have this conversation.
Wonderful.
Yeah, yeah.
How did you sleep, by the way?
I slept pretty good.
2:10
Yeah, I've got a couple of kids.
I've got a 5 year old and a 7 year old, and so if I ever have trouble sleeping, I can just go in there and snuggle those guys.
So always delightful, fun times waking up with them.
Totally different energy in the house than the four kids for sure.
Amazing, amazing.
2:27
So we met at A4M Advancements in Medicine and Longevity in Las Vegas this past December and your team had a really unique test that lots of people are talking about across the space of oncology and cancer and early detection known as Epiceek.
2:47
And that that is the test, correct?
That's right, Epiceek.
EPI seq.
So you know, this has been in my field of awareness for a long time.
We've not talked about it on the podcast.
You know, my understanding is this test is, is some sort of a liquid biopsy solution for early cancer detection.
3:06
So I would love to jump in and and am I getting that right?
Am I describing the test and in fact, how it works and how it functions?
I'd love to break that apart with you for the audience.
Yeah, absolutely.
So you, you said a lot of the right words there.
So it's a multi cancer early detection test.
3:22
It's a liquid biopsy.
This kind of testing is really something that a lot of healthcare providers have been asking for, patients have been asking for.
One thing we know about cancer is the later you diagnose it, the worse the outcomes for patients.
3:39
And we have some really phenomenal testing for some cancers where we can detect them early at colonoscopies, maybe the poster child right, where you can find that colon cancer before it's even technically cancer.
Treat that, get rid of it.
The problem is there's so many cancers and there isn't a great test for many of them.
3:57
So these cancers aren't detected until later when the patient's symptomatic.
What EPI seq does is it looks at the patient's blood, looks at some epigenetic markers in there.
So not actual DNA sequencing changes, but changes in part of the system that regulates gene expression and determines, do we think that this patient has cancer or not.
4:19
And it really is effective at looking at a lot of cancers and many cancers that we don't have effective screening for.
Incredible, incredible.
And I would love to understand both for myself and maybe the home listener that does not have an in depth medical background, how is this functioning?
4:38
How does it really work?
Yeah, so like, how does the test work?
What like.
Biologically, yeah.
Like, walk us through like, I'm sitting with my practitioner.
He's.
I said, hey, Freddie, you expressed interest in doing a liquid biopsy blood test for early cancer detection.
I've got a box in front of me that I've ordered from you.
4:55
What?
What happens next?
Yeah.
So that the thing that we're looking for is something happening inside your body.
So all of your cells are connected to your blood supply, right?
That's how they get oxygen, that's how they get energy.
Some of those cells change and start turning into cancer, right?
5:12
They're still connected to that blood supply.
Cells become cancer.
When they start developing cancer, they multiply more than other cells.
That's one of the hallmarks of cancer is this kind of out of control growth.
And as those cells are growing, some of them die.
And when they die, some of their DNA goes into the bloodstream.
5:30
So FEC, what we're doing is taking a blood sample.
So just a couple tubes of blood in your doctor's office at a phlebotomist in some special tubes that stabilize that DNA.
They get sent to us in the laboratory.
We do our analysis on it and we're able to kind of separate, do we think that this patient has cancer or we don't see evidence of cancer from this and it's really looking at that cancer DNA that's there in the blood sample.
5:57
If we were in a lab, what would the lab technician be doing?
You know, I know I've had guests on.
They've done advanced cell spectrometry.
Sometimes people are counting cells under a microscope.
What are you guys looking at in the biopsy?
Yeah, those are all great techniques.
We don't look at the cells.
6:13
So what we do is we take the cells, we get rid of them.
So we spin the tube really fast, create some artificial gravity to get the cells at and we're left with the cell free component.
That's called plasma.
We take that plasma and we do some chemistry on it that grabs onto DNA and let's everything else go away, and that's DNA isolation or nucleic acid isolation.
6:36
So now we're left with DNA.
Some of it could just be normal DNA.
So regular cells in your body are dividing, multiplying and dying and some of that DNA gets left in there.
Just the fact that there's DNA doesn't mean that there's cancer.
We've got to just do some more testing to determine is this DNA coming from cancer or from from healthy cells?
6:57
And what we do in the laboratory is a chemistry called bisulfite conversion.
It's a chemical process that changes DNA based on whether or not it's methylated.
And then we have some techniques that are similar to PCR that everyone's familiar with from COVID testing, where we amplify, we make extra copies of DNA that looks like it's coming from cancer.
7:19
We're able to detect that.
Then we've got some computer software that analyzes that, use some machine learning to help develop that and then make a determination of, hey, do we think this is cancer or not?
OK, so PCR is polymer chain reaction for for anybody, is that correct?
7:36
Polymerase chain reaction.
Polymerase change rate chain reaction and then you we, we talked about methylation pathways.
Can you explain?
Because this comes sometimes we'll say a term and I there's an assumption that everybody knows what we're talking about now.
Yeah, I have a supplement, my cabinet that is methylation support from Thorn because I want help methylating.
7:54
I've looked at my genetics and it says, Freddie, you might want this in your longevity stack.
Can you, can you describe to us the process of methylation and why it's important?
Absolutely.
So you've got different cells in your body that do different jobs, right?
8:09
But you only have one genome.
So that the genome, the DNA, you know, you got one copy of your genes from mom, one from Dad.
That's kind of a fixed static thing.
And it's the instructions for all of the protein machinery in your body, all the enzymes in your whole body.
8:26
But a neuron doesn't need the same machinery that a skin cell needs, right?
They've got very different jobs, but they have the same blueprints.
Epigenetics is the study of how does the body turn genes on and off in a healthy way and how are genes turned on and off in disease as well.
8:43
So aging is likely a methylation related disease.
That's why those supplements make sense scientifically.
And then cancer is also of methylation, epigenetic based disease.
So cancer, you get genetic changes, but also that same methylation framework that changes gene expression in a healthy way in different parts of your body.
9:04
It can use some of the machinery that normally isn't used by a cell.
It can turn genes on, turn genes off in a way that changes the behavior of those cells and helps them develop cancer.
Methylation is is one of those mechanisms.
Methyl is a little carbon that can get attached to adna in humans.
9:24
We talked about 5 cytomethylation.
So cytosine becomes methylation methylated at a specific site there.
And usually what happens is that methyl group is added in a part of the gene that doesn't get turned into protein, but it's important for the expression of that.
9:42
So do we want the machinery to lay down there and turn that gene into functional protein or not?
And so it's just flipping switches on and off that allows the cancer cell to use some of the machinery.
That's useful and helpful otherwise, right?
9:58
But in this context of cancer is dangerous.
Yeah.
So what's happening in the body, Essentially we're getting this abnormal methylation pathway.
Yeah.
So it's an abnormal, right.
So that the methylation that is normally there and healthy, right is changing.
10:13
And so we're getting activation of genes that may normally be associated with growth and repair, which is a good thing, right, growth, but out of control growth is bad and cancer has out of control growth, right.
And so some of the same methylation things that can be useful during that healing process, healing is done and now it's causing disease.
10:34
Yeah, yeah.
I wanna just step off the trail for a second and just, you know, what's always amazing about the human body is we talk about the genes and, and you know how many we have a blueprint for cells and then there's so many more protein expressions than we have.
10:49
Like the blueprint for that is always been one thing that I'm like, it's hard to imagine a system that's more intelligent than the human body, right?
It's just got to do all these incredible things.
From the small amount of how many protein expressions are there, like 140,000, it's a lot.
11:06
We've about 20,000 genes total, right?
So that's, yeah, coding things.
But those can be recombined and modified in different ways.
So we call them isoforms where, you know, in one biological context the gene will do one thing and in another context it'll be cut up differently, twisted around differently and do something else.
11:29
So you're, you're absolutely right.
It's almost like a compression algorithm, right?
Where you've got all this data and then it's been compressed down into this tiny footprint.
It is beautiful.
Absolutely.
Yeah, it really is.
I mean, if you ever wanted proof like a higher power, it's like wild and it's math, you know, that's the other thing.
11:45
There's like math involved in all this.
You know, coming back to I'm in the room, right?
I'm in with my doctor, I've got the box, I understand the test and I've run.
I've got my blood draw, right?
It goes away.
How long does that take to come back?
Average.
Normal.
Average.
So our goal is to get it back to you in a week and we do that over 90% of the time.
12:05
We get those results back in a week.
Yeah.
OK.
And what am I getting when I come back to the test?
What am I going to be looking at?
So yeah, what comes back to you is a report.
So we generate a lot of data, look at a lot of data, have algorithms to do it.
We talked to patients, we talked to doctors.
12:23
You probably don't want all that data.
You want the answer, do we think that there's cancer or do we not that there's cancer, right?
Those are the things.
So we've really boiled down the report to either saying cancer signal not detected, so we're not seen in this blood what we would associate with cancer or we're seeing an abnormal methylation signature.
12:43
And then there's a lot of language that we've kind of developed to help explain to the doctor, to the patient what's there.
One thing I feel like we should know is this is kind of new testing.
So most doctors order colonoscopies, order mammograms on their patients, perform pap smears.
13:00
They know what to do with those results.
But this is cutting edge stuff.
And a lot of doctors aren't super comfortable, don't know what the next steps are.
So during this period, it's really important for us as a laboratory to support those professionals.
So anytime we have a positive result, I'm on the phone.
13:17
So I'm the laboratory director, medical director of the laboratory.
I'm responsible to make sure that the follow up is appropriate there.
So I'm on the phone with the ordering doctor, talking to them and often times talk to the patient as well.
So we really do want to make sure people understand what the next steps are, what happens after a positive result happens.
13:34
Yeah, I have so many questions, so let me ask you this.
Yeah.
Let me three question.
If 100 people run this test and you know and maybe you've seen the scope of tests come in over time or you know that the this technology has been developed for a little while.
13:50
If 100 people take the test, how many people come up with an abnormal methylation pathway or abnormal results?
So let's up the numbers because most people don't have cancer.
So let's say 1000 people or in the text 1000, a thousand people, most of those people do not have cancer currently, right?
14:07
We think it's somewhere between half a percent and a percent would have cancer, right?
There's also any time you have a laboratory test, the possibility of false positives and false negatives are there, right?
So you've got a sensitivity, specificity.
14:23
We really strive to not tell people that they might have cancer if they don't have cancer, right.
So we try to set that the marker for that is something called specificity.
It's how likely is a positive result to be positive kind of situation.
So in those thousand patients, maybe five of them would have positive results and they end up having the cancer and then five patients in that group would have a positive result also.
14:51
But in the work up for it, we can't find a cancer.
So there's no cancer 'cause there's something else causing that methylation signature there.
So 5050 doesn't sound great, right, For a positive predictive value, you know, that's, that doesn't sound stellar.
But that is the cost for being able to detect these cancers early, right?
15:10
If we, if we made it, we were 100% certain we'd only be able to pick up the really late stage cancers and we wouldn't be able to change health outcomes.
So that's part of the kind of calculus of designing the test there.
Yeah, Who would you recommend to get the test?
So if you had a magic wand and you could say who's who's this right for?
15:29
Yeah.
You know, I was in charge of making decisions for the whole healthcare system.
The test is more beneficial if you're more likely to have cancer, right.
And so the older you get, the more likely cancer, you know, it.
It just becomes more and more likely over time.
15:46
So one way to do recommendations for cancer screening is looking at the age and then some of those statistics, you know, positive, negative predictive value in that setting.
So certainly patients 50 and above will benefit.
Cancer really starts sticking up there.
16:03
I would start getting the test when I was 40 because I think that that benefits outweigh the costs at that point.
But people can make their own decisions.
And we've had people in their 20s get the test.
We've had people in their 30s get the test as well.
You know, cancer can happen before the age of 40, certainly, right?
16:20
There's no cut off.
That says it happens only at these certain ages.
So it's really going to depend on kind of your own personal desire to know kind of things there.
The other group I think really it makes sense to do are people that have, you know, a family history of cancer that's abnormal.
16:40
Maybe they know that they are a carrier for a mutation that increases the risk of cancer.
They have some other risk factors for cancer for maybe a work exposure or something like that.
So just based again on kind of assessing that personal risk and determining does this make sense or not?
16:59
Yeah, yeah.
I mean, in my head, I'm like, you know, over 50, smoking, excessive alcohol consumption, lack of mobility, obesity, family history, something a genetic predisposition like Lynch syndrome that that would be a, you know, a good portion of the population who'd say, look, you know, check the box.
17:17
And again, I think it comes back to the point you made this test.
It's not about a 100% accuracy, it's about early detection.
So we're using the tools that we have in the toolbox today.
For me, I and I, I'm saying this all and it was like, Oh my goodness, what a personal choice this is.
17:36
Because I'm guarantee you there are people that are like, I don't want to know that.
Absolutely, yeah.
Yeah.
I was talking to my dad the other day.
You know, he's in the age group that I think would benefit from this.
He'd prefer not.
He doesn't want that information.
You know, to me, we can do something about it, right?
17:52
Like if we can make a change and do something about it, I'd like to know.
There's certainly, you know, genetic things that we can't do anything about or I'd prefer not to know, right?
There's some genetic disorders.
You know, I had a APOE 4 and my risk of Alzheimer's disease was greatly increased.
18:12
I'm not sure I'd like to know that information, right, Because I don't know if there's anything we can do about it.
I probably would like to know because we're learning things right?
And I could be on the lookout, make some lifestyle changes.
But I, I definitely understand people not wanting that information.
18:29
And then if if you're the type of person where you know a false positive, which is a possibility here, if that would cause you, you know, personally undue stress about this, then I think you can make the personal decision and say this, this wouldn't be worth it to me for a 5050 in that period because it is it is very upsetting for people to find out that they may have cancer.
18:52
That is not something that anyone would like to hear.
It is, but I will tell anybody that hears this on this podcast, anybody you listen to this that's upsetting, I promise you it is way more upsetting to wander into an emergency room and say, Freddie, not only do you have cancer, but you have 9 tumors that had spread throughout your abdomen, surrounding your kidney, the vena cavity, heart.
19:15
It's so different.
I know it's scary and there's so many people out there with these stories of just, you know, going through late stage disease that the odds were severely stacked against them.
We've had Casey West on the show.
19:31
He's a Marine who has had stage 4 glioblastoma.
He's three years out, right?
He's defying the odds.
And it was a situation where he had wandered in dizzy with headaches.
You know, we're, we're talking, there was a progression.
So I personally, I would just tell everybody that, yes, it's scary.
19:51
And I also think, you know, dig deep in your soul and see if you have the courage to meet your body where it's at, because I promise you that stage 1 is way less severe.
And I we just did a podcast yesterday on testicular cancer and a male who had it once.
20:06
It was just a small primary tumor and then, you know, 13 years later, reoccurrence in the abdomen, retroperitoneal lymph node dissection, severe recovery and repercussions of that surgery.
So it's, I don't know, I'm just, I'm so excited, man.
I would have loved to have this information, but it'd be tough to swallow it as 26 year old to be like, are you kidding?
20:27
It's not going to happen to me.
I'm Superman.
And that's exactly why I waited so long to go seek any kind of help.
Yeah.
Yeah, definitely.
Yeah, I think for me, the case is clear that this is beneficial, right?
This is why I'm working on this, why I'm in this field.
20:42
I think we can really help people.
We can change the face of cancer in a lot of ways here and prevent just unnecessary suffering, unnecessary death in the field.
But as a physician, patient autonomy to me is still paramount, right?
And so that's, that's why, you know, if you've got to make this decision for yourself, you and your doctor together is always, I think, sound advice.
21:06
Yeah.
I love that energy, Josh, and I respect that.
You're not pushing this.
You're like, here, look, here's an option, here's the science, here's what this tool does, here's what we can find, here's the possible benefit.
But I really do respect that because I think it is a highly delicate situation and everybody's going to have a different take on this given the relationship with her body and the medical system and their doctor.
21:29
And, you know, I could go on and on.
Can we talk about, so I actually heard about the test.
You know, I was, I was probably listening to a podcast.
I was probably listening to a podcast with Tony Robbins.
He was talking about some he's like, Oh my God, the face of medicine is going to change.
21:45
We're going to do, you know, something with this test.
So we're going to be able to do all these things and you, you're never going to have to have late stage cancer again.
And I've, I've not done the test, I've not done the test.
I've, I've actually asked for it and just never went through with get in the box and draw in the blood and I've waited because I'm, I think AI do labs 4 * a year.
22:06
If I feel anything, I go get a scan.
I check the protein markers, you know, the alpha BCHG, alpha Theta protein, luteinizing hormone that were associated with my cancers.
Whenever I have a concern, that's the, you know, so I do a lot of stuff and, and then the lifestyle stuff.
22:22
So I feel good and I just waited.
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I would love to know because there's a couple tests on the market, are they doing exactly the same thing?
23:44
Are there different levels of efficacy?
Can we talk about that a little bit?
Yeah, absolutely.
So there, there is one test that is kind of the market leader here and I'm not going to mention it by name, but you can, you can probably figure it out and it's very similar to Epic.
23:59
So there's a lot of things that are similar.
I want to say I think it's a fantastic test.
I know people that, that work for this company.
I think they're doing great work and it really was a leader right and raising awareness in this field and cutting edge in the development of some of the things here.
24:16
So there's a, a test that's out there that is also looking at cell free DNA methylation signatures.
It's using a different, instead of using PCR polymerase chain reaction the way that FPC uses, it's using sequencing, which I've run medical sequencing labs that's been most of my career has been doing that work.
24:37
And it's a fantastic technology because you can look at basically more information at the same time, but it's a more finicky technology.
The stars kind of have to align for you to look at pieces of DNA.
24:53
And a lot of the time with cell free DNA, your body actually fights against cell free DNA.
So the viruses have DNA and your body doesn't like viruses.
So as soon as that DNA is out there in your bloodstream, your body is trying to take care of it because it could be a virus, you know, it can't really tell the difference.
25:12
And so this DNA is often in really small pieces and it's damaged.
Sequencing can have a difficult time with that because it needs everything to be perfect.
It needs the chemical to be correct on both ends, to adapt some things on there.
25:28
So there's a lot of things that can go wrong.
PCR, on the other hand, can work with damaged things.
You can have a basic sites, it's a more robust look, but we can only look at a handful of targets.
So what we did is we're using this technology that maybe can look at more molecules of DNA, can detect a lower amount of DNA, but a limited number of markers.
25:54
The other test is looking at a huge number of markers, but it's only getting the really pristine pieces of DNA.
So that's kind of a 50,000 foot view of the difference.
The advantage of PCR here is in early stage cancer, the amount of DNA that's out there could be very low.
26:13
So we're talking about nanograms, you know, .1 nanograms, really tiny amounts.
So in that tube of blood that you get drawn, right, there could only be a handful of molecules.
And if we lose those molecules because they've been damaged or something and we're not able to detect them, then that's going to come back as negative, right?
26:33
And so it's this needle in a haystack look, and that's kind of one of the main technical differences between the two.
And so we have some data that's out there.
We have published data.
We're continuing to do clinical studies, those early cancers where I feel like we can have the most impact.
26:50
I think that that's where PCR has some advantage for sure, and being able to detect those really low levels of DNA.
Yeah.
And remind me, what's the price point right now of EPI SEQ?
EPI seq Right now I believe the list price is $700.00, so 699 OK the.
27:07
Price .699 great and I think I from memory serves it's been a while.
The other test is like 1000 bucks.
That's ballpark, Yeah, I think that.
Ballpark do you guys have what is your vision for APC cuz there a price you want to get it to Is there like two-part thing?
27:23
Is there a price you want to get it to?
Is there a?
You don't have to answer that, but is this something insurance covers?
So I'll answer the second question first.
So currently no insurance does not cover any multi cancer early detection test.
A lot of the work that I do with this company in other laboratories is helping make the case to get insurance companies to cover a test.
27:46
I think it's only a matter of time before insurance does cover it that the data is strong, right?
The case if you talk to a human and you explained we can detect cancer earlier, they need to protect the money that is coming in as premiums, right?
You don't want to spend that on things that have no scientific or medical merit obviously, right.
28:05
But I think there's a good case for this to happen.
I think we're probably a few years away still from getting insurance coverage and that I can't speak to a specific price point for Fe seq, but one of the advantages of this technology and what we're driving towards now is really reducing the cost and complexity.
28:26
So next generation sequencing that other technology platform form the equipment cost millions of dollars for the laboratory, right.
This test EPI seq really this is equipment that was broadly used during the COVID epidemic, right.
28:41
And so we've got a lot of more accessible technology there.
I think one of our missions is to make cost effective testing, testing that anybody could afford, right, Even if insurance wasn't going to cover it.
I don't know if we've achieved that yet with the $700.00 price point.
28:58
I think we're continuing to make improvements to the process of the technology to try to get that price down, yeah.
Yeah, I mean, again, I'll just say from my experience, you know, 18 thousand, $19,000 a week for just the one chemo infusion per week, you know, it's she's expensive, it's an expensive journey.
29:17
So it's again, I want to pivot to let's say I am, you know, one of the five out of the 1000 and I get back abnormal results.
What do I do?
Yeah.
So it's really going to be kind of you and your doctor together at that point figuring out what the next steps are.
29:37
So in just anecdotally here, not not showing personal details, but in the cases that we've had positives, the majority of them I've talked to the doctor, we've kind of reviewed what's going on with the patient and there's something there, right?
29:53
So it wasn't a completely asymptomatic patient.
They had a concern, right?
And so the the first thing history and physical, I teach at a medical school as well, right?
This is the supreme diagnostic tool is talking to your patient and finding out what's going on in their body, right?
And so if we're able to direct next steps by what's going on in that patient, you know, if they have, you know, actually I noticed a breast lump, right?
30:16
That was one of the cases was after the result came back, we worked that up.
That was the answer.
That was the diagnosis, right?
Another one, you know, Oh yeah, I, you know, I do have this, this other lump here.
So if there's something, if there's anything we can use from history or risk factors for certain cancers, we can explore those things.
30:37
In the majority of cases, the next step is imaging to determine what's going on.
So we recommend currently a PET CT scan as a follow up.
The CT part of it is looking at kind of the structural image of the body.
30:52
The PET part is a positron emission tomography that's looking at where is sugar being used abnormally in the body.
One of the interesting things about cancer is it uses sugar differently than the rest of the body.
So where are we using sugar abnormally?
And so you've got kind of imaging findings, you've got this biology, this methylation that's there and the next steps are directed from that point.
31:15
Yeah, fascinating.
I'm always oh God, who was it?
I was just watching and I was watching in a documentary on Otto Warburg who was looking at the changes in a cell.
Otto Warburg changes in a cell and it's it's milli, it's voltage or you know how it's functioning, how is breathing, what it was using for fuel.
31:34
And I wish I had a date in the middle of my head when this discovery was made.
The 20s was it 1923?
It's been a while since we understand.
So this mechanism that cancer is definitely a component of the fuel for a cancerous cell or a tumor.
31:51
Yeah, I think you're right.
This is like 100 year old science, still very fascinating, still useful information, right, where the cancer is switching to a different energy metabolism system, certainly still something we're targeting drugs toward, something we're exploring to see.
32:09
Can we look for that as far as a diagnostic tool and a blood based test as well?
Definitely interesting stuff there that I think is underappreciated.
And it is, it is old science, right?
This is this is an old study, Yeah.
Yeah, even the chart like how I I forgot how they were doing the measurement, but it was measured in a healthy cell had a a trans membrane potential.
32:32
It held it a, a voltage, a milli voltage, you know, from the outside of the cell to the inside.
And that change that dropped dramatically when a cell became cancerous.
And it was actually they had I'd remembered seeing somewhere there was a chart where it was a healthy cell to it's it's doing OK to chronically I'll cell to cancer.
32:50
And there was a progression in that milli voltage drop and it's an energetic thing as much as it's a physical thing.
So, you know, take that how you will on the podcast, but just fascinating reading and definitely somebody to look into.
You know, what are your thoughts on where we're at is let's focus on the US.
33:09
You know, I think there's a lot of ANYWAYS, within my field, within my little silo, my area of bias, there's a lot of dissatisfaction with healthcare.
If we'll say that, you know, that the joke is that it's just disease management that and that's, you know, if we look at it, we do manage a lot of illness.
33:25
We don't necessarily there's not a lot of cure.
I've always been such a big believer in the environment or the epigenome of my life choices are impacting health.
Like how do you think the war on cancer is going in America and how much would you like to see of that conversation around the the epigenome of somebody's lifestyle be brought into play and in the world oncology?
33:46
Yeah.
No, that's AI think a great criticism.
Certainly we focus on disease and disease management and not on optimizing health.
That's what our medical system has kind of traditionally been built around and that's what, you know, the financial structure is also built around is how complicated is this patient based on diseases?
34:07
What do we do based on complaints diseases instead of how do we optimize this patient's health?
And even when you talk to specialists, right, the more specialized somebody gets, the more laser focused they are on kind of the organ system and the things that are there, right?
34:24
And it's, I don't think anyone's doing it maliciously, right?
You're spending the bulk of your time with very ill people, and it changes your perspective on what your role is.
You know, there's so much momentum for you to behave that way.
The doctors that kind of break out of the mold and go into functional medicine and Wellness, I'm very interested in that because it is so different that the evidence you evaluate is different.
34:50
It's a very different situation.
I'm a pathologist.
Pathology is the study of disease.
So I'm the most disease specific type of person that there is.
But as a patient, I recognize, you know, I go see a neurologist and they're not interested in my life.
They're interested in this extremely narrow portion of my life that, you know, that's what they want to talk about.
35:11
If I've got other things, they may not be open to it.
So I feel like I went off topic a little bit there.
No, listen, it's, it's great.
Yeah.
In oncology, I think we've made some phenomenal progress, right with there are cancers.
35:27
Once you're diagnosed with cancer, we've optimized how do we study that?
How do we figure out which treatments work the best?
How do we compare treatment algorithms?
How do we integrate genetics in to find out that the treatment that's going to work for you, not for everyone.
35:45
Oncology is the part where precision medicine, which is that field of kind of tailoring medical care to a specific person, not to just a disease in general.
That's where we've made the most progress in medicine overall.
But I do think we still have a ways to go in that.
36:02
In medical school, we talked about something called the bio psychosocial model, where the biology part of it, right?
That's where we're focusing on disease and specific cellular mechanisms, etcetera, right?
That's only one component of caring for a patient.
36:19
The patient's psychology, how they're dealing with it, how you're presenting information to them that is as important for kind of their experience in the disease as if you're picking the right medicine to give to them, right?
It can be a very different situation there.
36:35
And then the social kind of framework as well.
Obesity is a great example where, yeah, we're developing new drugs to help fight obesity, but what are we doing to help as a society fight against the obesity epidemic, right?
36:50
What are we doing for psychology and some of the things that are contributing to obesity there, right?
Where again, we can get reimbursed for a medicine.
And so there's money and resources going to that, but it's only one component of the whole problem, if that makes sense.
Yeah, yeah, I think, you know, we've touched on it a couple times.
37:09
It's it sounds to me like it's shifting that incentive model over time.
So while we wait for that is people, I always, I always remind, you know, you don't, you do not need legislation to change so many of the big needle movers today.
You don't need legislation.
37:26
You don't need a bill.
You don't need a permission slip.
You don't need someone to tell you.
You know, it's really like tapping in and saying like, look, there are guiding principles of nature that we are, we have, I think we've traded off with advancements in technology and, and we can look at those and examine and probably all know what they are.
37:41
I know I am so addicted to my phone.
I mean, it's even if I go into like have a bowel movement, I was like, I don't want to go with my phone.
What am I going to do?
You know, it's just like it's wild the pull that it has on my psyche.
So that is, you know, in this nervous system that is calling out functionality to my organs.
37:59
I can't imagine how that's not impacted.
So long winded answer, answer to say there, there's so much that we can address with that.
Like what is that rhythm?
What's the tone of my nervous system?
You know, I'm never allowing a state of ease during the day because we're doing more.
There's more information, there's more access to just, you know, we have supercomputers in our pockets.
38:19
We do, yeah.
There's pluses to it, and certainly some minuses as well.
Yeah, 100 percent, 100%.
So I'm going to do, I'm going to do an APC test and we're going to have another person from your team on hopefully back in the future.
We're going to keep this ball rolling.
38:36
I feel like this is a good bird's eye overview of what we can do.
This is the other thing I wanted to ask you before we go off this topic with this technology, are there certain cancers that are more probable of being detected than others?
38:54
Are there things that really like this type of technology would knock it out of the park on and maybe some that it's it's not so good at yet?
Yeah, definitely.
So great question there.
There are strengths and weaknesses to the test just based on the biology of the cancers.
39:09
So we talked about cell free DNA coming out of the tumor.
It looks like some types of cancer don't release as much cell free DNA.
We have a difficult time detecting those and so the two ones where multiple, you know, different people have trouble detecting them would be prostate cancer.
39:28
It is difficult in a blood sample to pick that one up with the DNA based method.
And then breast cancer can also be very difficult to detect.
There isn't a lot of cell turnover.
Just again something about the biology there.
We do have some information, I'm not sure if it's in our current publications, but we will have one coming out soon that kind of breaks down cancer by cancer, how we think the performance is, because that's really important information, especially if you're looking at a specific type of cancer you're worried about to know that information.
39:58
So we're trying to get that out there.
Yeah, I know because there's a on the website on a precision dash epigenomics.com, there's like a scroller and it's like stomach, bladder, kidney.
It's like showing me the organ systems because I think there's 24 types of different cancers that could come up as abnormal pathway on the test.
40:21
Is that correct?
Yeah.
And it could be more than that as well.
So when we were designing the test, our goal is to detect cancer, right, and not really a specific cancer.
So we looked for a signature that isn't specific to one cancer or another, but it's kind of specific to cancer as a disease process.
40:44
So the things on the website are likely cancers that we have detected with the test.
So we've kind of shown, we've got evidence, you know, we've got the papers to show we've detected this cancer.
Now there are a lot of cancers out there, right?
And getting samples, doing these studies, we're continuing to do that work.
41:03
So we'll continue to update the things there.
But the test isn't really limited to a specific set of cancers.
Does that make sense, Freddie?
Yes, yeah.
A couple more questions.
Is there anybody that should not do this test?
We recommend against in people under 18 and then also it's possible in pregnancy as well that false positives could be there.
41:28
We haven't had any yet in in pregnant individuals, but pregnancy is its own epigenetic behemoth.
A lot of placental expression and brinal expression right, of methylation patterns are shared with cancer.
And so we suspect the test may not be as specific in that population.
41:47
So those are the two where we just don't have the data to say, hey, the false positive rate, it could be higher here.
Wait till that that baby's delivered and then we'll do the test then.
Yeah.
And so if this is something I want to get, do I just go to the website and I order a test or is this something my doctor orders?
42:06
Yeah.
So it's not available to patients right now without a doctor's order.
We really value that kind of follow up with your doctor on, on those findings.
We really don't want somebody to find out something, you know, in isolation.
That's a bad way to find out, you know, some news where you don't have follow up.
42:22
So we do require a physician to order it.
You can look online, there's an order form there.
You could print that out and bring it with you to your doctor and say, hey, I'm interested in this testing.
That's a reasonable thing to do.
Any good doctor would be fine with that kind of approach.
42:38
Great, Yeah, that sounds really clear.
Amazing, amazing, amazing, amazing.
I thank you for your time.
I'm super excited about this.
I feel a much better level of education speaking with my friends about it when they're asking me about because I I just got before we popped on yesterday, someone's like, do you do the circulating liquid biops?
42:56
I was like, not yet.
I was like, I haven't done it yet.
I don't know enough.
I don't know enough.
But it's it's this has been really, really clear.
I think this is going to be incredibly valuable for people to to hear.
And then interesting you said possibly the two that may not perform well like breast cancer and prostate cancer, We have great screens for those already.
43:15
Yeah, absolutely.
Amazing.
It doesn't mean that it wouldn't pick it up.
It just means again, that that sensitivity, right, our ability to pick it up early May be limited.
Yeah.
Absolutely.
Yeah.
What I'm hearing you say is this, this is not, it's great test.
It's it's not a pass for you to go live like an ass.
43:32
Like you still have to like do all the things and you still have to follow up with your primary care annually like you normally would and listen to your body.
Yeah.
And it's, it's not a replacement for the other screening tests that are out there.
Those are kind of directly testing the tissues themselves, right.
43:48
This is an add on addition to those things.
So that's another other point.
You don't want to do this instead of a colonoscopy, for example.
Yeah, well, I just, it's, you know, again, it's near and dear to my heart.
I just had a family member go in for their first mammogram.
No symptoms and breast cancer, some levels of metastasis.
44:07
There was no signs, right.
And so I, I just think, you know, in the world that we live in, there's lots of change.
Again, we mentioned the swing away from the guiding principles of nature.
I think it's for me, it's a smart investment.
I'm definitely going to do 1.
We'll definitely do a follow up episode so we can get into the details.
44:22
We can look at a print out.
But I think this is a great starter.
The beautifully broken podcast, Doctor Ruth where my title at Doctor Ruth, just so we get more traction.
I joked about that, but now I think it's a good idea.
Doctor Ruth talks cancer in this world of, of being beautifully broken.
44:39
And you know, this idea of when we fall and we put things back together, that's an opportunity for healing.
What does it mean to you to be beautifully broken?
Oh, what a great question.
I mean, to me it's maybe about accepting that, you know, this is a broken world, that we are broken and we can still do great things, we still have value and things can still have value.
45:01
Yeah, yeah.
And then if you had a magic wand, I'll let you have the magic wand again.
You can tune in.
All the self will do.
Cell phones, not the TV's.
Cell phones of the world.
They get to TuneIn, to Doctor Josh in the state of the world right now, You know, there's a lot of turmoil going in, a lot of polarity.
45:17
What would you say to people right now?
I don't feel remotely qualified to be saying anything, especially this week.
Ready.
Hang in there.
I guess we're going to be OK.
Yeah.
We're going to be OK.
We're going to be OK, yeah.
45:33
I say the waves keep coming.
You know that they're going to keep coming.
Yeah.
Great.
Great.
All right, big love.
I'll talk to you soon.
Thank you, Freddy.
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46:51
Let's go, let's grow, let's repair.
Ladies and gentlemen, here we are with Season 9 of the podcast.
We're about to Crest into year 6.
Can you believe it?
47:06
I'm so glad you're still here.
And I just wanted to remind you, if you like the show, please head over to Apple or Spotify and give us a five star review.
It really expands the listenership.
Now, there's one big way you can continue to learn and deepen the relationship that we started in this very episode.
47:26
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47:44
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Beautifully Broken all one word and they do support the podcast through affiliations.
Now if you want to see the faces of our guest and you want to watch me unbox products and see reviews, you can go over to YouTube at Beautifully Broken World.
48:05
Now this next message is from my vast team of Internet lawyers.
The information on this podcast is for education.
By listening, you agree not to use the information found here as medical advice to treat, diagnose or cure any medical condition in yourself or others.
48:22
Always consult your guiding position for actual medical issues you may be having.
Now, in my closing, we are truly in a paradigm shift.
We need you at your very best.
So use these conversations as a jumping off point for further exploration.
48:41
Always listen to your own body and remember, while life may be painful, how we put the pieces back together is a beautiful, beautiful process.
I love you so much.
I'm your host, Freddie Kimmel.