Dr. Venable: Welcome to the Veterinary Cancer Pioneers podcast, the show where we delve into groundbreaking work of veterinary professionals who are dedicated to advancing the field of veterinary oncology. I'm your host, Dr. Rachel Venable, and I'm thrilled to embark on this journey with you.

I'm your host, Dr. Rachel Venable, and today I'm so excited to interview our guest, Dr. Craig Clifford. Dr. Clifford started veterinary school at the University of Mississippi and then did his oncology residency at the University of Pennsylvania. He has an extensive lecturer. If you've been to very many conferences or webinars, you often see his name if there's any mention of oncology. And he's also authored over 70 papers and book chapters. He's part of the VCA Pet Cancer Care Alliance Committee. He's been on several committees at VCS and ACVIM. And so very connected, and all the networks were excited to hear his thoughts about the different clinical trials and just our profession and how he's seen it change. The other thing that's interesting is that he's an examiner for the Australian Oncology Specialty Exam. I thought that was sort of interesting when I was reading your background. How did you get in? You're not Australian, how did you get into that? 

Dr. Clifford:  No, no, no, I think what happened was the, I think I lectured at one of the VCSs, and some of the Australian group had come over and had just chatted with me that right now, or at least at that point, they didn't have many of them that were present in Australia. So, the hard part was that they didn't have many of them. was all of them were training, and it's a conflict of interest to be writing the exam and your residents taking it. So they were looking for some outside help. So I was able to go out there twice to do the exam. It's a lot of fun long trip. But it was Australia's beautiful. So I got to spend some nice amount of time there. And I thoroughly enjoyed it. 

Dr. Venable: Well, that's exciting. How fun. I was hoping you said you got to take some trips out there because that would be…

Dr. Clifford:  Although the first time we were, my wife and I had gone we only stayed I think four days so that was rough because it's, you know it's 12 hour or 13 hours time difference, so we definitely were a little jet lag coming home.

Dr. Venable: Yeah, four days does sound a little tight because it probably takes almost two days to get out there from where you live it with you know with layovers and things so. So yeah, well, that's, that's really fun. And thank you so much for being on this podcast. Like I said, I'm so excited to just kind of pick your brain, you know, because you've really been heavily involved in clinical trials, and you work with a lot of different companies and startups and things. And so, you know, I think, especially for some of the younger veterinarians out there, how did you get involved in something like that? Like how, how can you branch out, you know, so you're not, not just doing private practice, but you get to kind of dabble in other things? 

Dr. Clifford: Yeah, I think I knew during time period of my residency and I was very blessed at Penn. I had a great mentor, Karen Sorenmo and Lisa Barber that I didn't think academia was gonna be for me. You know, I had what I would call an academic edge, meaning I love certain aspects of academia. I love publishing, I love lecturing. I love being involved in clinical trials, but I did not. want the day-to-day academia things I enjoyed being in practice. And even during my residency, I worked on some weekends at Red Bank, which at the time was the largest privately-owned hospital. And that was great. Like I truly love the idea of being able to do those things. So when I finished my residency, I started at Red Bank and I had gone to the owner, Dr. Tony DeCarlo and had discussed, you know, I'd like to create a hybrid hospital. At least within the oncology front, where I can do some of these academic things, but still maintain my regular duties. And it took a bit of showing him that, you know, there was value in clinical research, but when we started getting trial after trial and he saw the revenue that was generated from it, he was like, why aren't we doing more of these? So that was helpful. It was hard though, because, you know, in order to really be able to do it, you have to have everybody on board starting from management, because somebody has to be able to sign contracts, look at master service agreements, you need to be able to create budgets. Your whole team has to be on board that they want to be doing these types of trials, because if you have individuals that aren't, that makes it hard to accrue cases, because they're not going to push for it. And of course, you definitely need the nurses involved as well. So it really has to be a team effort. And, you know, we've really tried to work it with most of our clinical trials that the nurses get something extra because we all know, unfortunately they're not paid nearly as well as what they're worth. And this was a way to help supplement their income. Plus it gave them, you know, the ability to be exposed to clinical research. And I think that was a benefit. 

You know, I look fondly in that my head nurse who is a VTS in ONCO may be leaving me for research, true research, joining one of the contract research organizations, and it's because of all the clinical trials we did, she found she had a love for it. So she may actually even know I'm going to be sad to have her leave me, I'm proud that she's moving on to do research, and it's all because we were doing it within our clinic. 

Dr. Venable: That's so many good nuggets in there, you know, is how you can help another way to add revenue, not just to the clinic, but also to your technicians. So that's a really good point that I think a lot of people haven't really thought about with clinical trials and also how neat that, you know, one of your staff has really found a love. I feel for you, losing your best techs are always hard, right, or your top leaders. And I know for me, I always struggle. It's like, you're excited. I had one that I... pushed her a bit 'cause I was like, man, you could be a great manager. And then lo and behold, she left and got a degree in management is doing it. 

Dr. Clifford: It's bittersweet.

Dr. Venable: Yes, yes, I was proud, but I was like, oh no, don't leave me, but that's really neat. Now, like you said, it's a bit hard to get started 'cause you just have to get things lined up. But for vets that are interested, especially oncologists in clinical trials, how can you get involved? That was one thing in private practice, I wanted to get involved with more, but I didn't really know how to go about that.

Dr. Clifford: Yeah, I mean, it certainly can be tough. I was blessed in that because of my residency, I had a lot of contacts to start up with, but a lot of it was going to VCS, seeing studies people were working on, and saying, "Hey, we have a big caseload, can I help?" So when starting with just simple things such as retrospectives, that's what we used to present most of the time at VCS. So I would either find the person who presented that research or get their email and email them and be like, "Hey, can I help contribute cases?" So that kind of got us a link in with a lot of the academic centers because several of the academic centers may not have the same caseload as we do. So we were then able to show them that we could help that way.

The next step then became when some of the academic centers were looking to do prospective studies, we asked to be part of it, could we be a satellite group or another site for you? And we were able to show that we could do it and we could do a good job and then that opened up more avenues. So I think one option is certainly, to look at the people that are doing research or presenting and if there's things that we're working on, you know, take the time to go find them or email them introduce yourself and see if you can be involved that way. 

The second would be if you have contacts at your university that you had come from and they're a university that does clinical trials see if you can be one of a sites you know they know you you had come from there so they have faith in you and can that be a nice bridge between academia and referral clinic.

The third would be reaching out to the different contract research organizations. The biggest one is animal clinical investigation, ACI for oncology, but there are others that do oncostudies as well. So reaching out to them, normally ACI wants to have more than one oncologist, so if you are a solo, that does make it harder. But the reason they want that is if something happens with the case and you're not in, you know, who's looking over it. So I understand their mentality and why they want to have more than one. But, you know, speaking with them to see if you can get on the track to be able to do these things. And then the final way, especially probably, you know, 10, 15 years ago, a lot of these small startups, you know, if you're in an area such as California where many of them are centered, you know, they're there, they come to you and ask you and you can certainly work with them. And... talk with them about, you know, how you can be involved and how you can help start up. So number of different ways to go about it, but you got to be proactive. It's not going to fall in your lap. You need to definitely take the reins and show you want to do it. And it's feasible. We've definitely proven that. 

Dr. Venable: Yeah, that is interesting. Like you said, that getting more revenue for the clinic and more revenue for the tech. So that's a good thing. That's just to mention, you know, how can we advance the science, right? We don't want to keep providing the same care we've been doing for years we want to make it better and have especially in oncology we want better outcomes I feel like until it's cured, there's not a better outcome right like that we got to keep pushing the boundaries see what we can do. And I guess kind of along the lines of pushing the boundaries did you ever run into any, I don't know if ethical is the right word, but just sometimes with clinical trials or new treatments or new diagnostics did you ever have trouble maybe with staff being concerned or clients or anything like that? Or how did you deal with situations? 

Dr. Clifford: Yeah, I mean, that's a good question. I mean, normally what would happen is the group of oncologists would look over the study and see, do we feel this fits with us? Where I am right now, you know, I was recently the director of BluePearl Science, when we would obtain these things, we would have to look at them and say, does this fit with BluePearl's principles? And if it doesn't, no. The other thing that with our group that we would look at is, is it a good budget, meaning does it pay for things? Because the other positive that we didn't talk about is that oftentimes clinical trials offer an avenue for owners that may not be able to afford any care. The number of owners I have had leapfrog from study to study is tremendous. And I honestly feel that many of the owners who do it are the most committed owners because they're so thankful that they had something they could offer their pet because otherwise, they were in just a bad financial spot they couldn't. And I've also found that sometimes the clinical trial owners, you know, it may be just a short period of time that financially they can't so they do the trial. And then things change for them and now this owner wants to go the full Monty and do the standard of care. So I think that there's a huge amount of it that can help owners out there. And I think that's a wonderful aspect. But getting back to your exact question, you know, we would review it and look at it. So if it was say, no control, or there was a control group that had no therapy, ethically, I won't do that. Unless it had a quick trigger, meaning, say it's a lymphoma study. And if the owner felt a day later, the nodes are bigger, and I come in and measure them and they are, and I can switch them over to what's called the crossover group, then I would do that. But to me, ethically, if there's a control group that's not going to get anything and there's no benefit to that owner, it's not going to be something I would ethically or my team would ethically feel comfortable with. 

Dr. Venable: And that makes a lot of sense. And have you found any diagnostics or treatments through these clinical trials that now you use, like you were, it was part of a trial and now you use it more commonly in your practice? 

Dr. Clifford: Yeah, that brings up a good point I was gonna bring up in regards to the nurses. One of the things that my nurses loved is that they would go to ACVIM or at VCS where people would present what's new. And they're like, we did this three years ago as part of a trial, you know? They're like, there's nothing new for us 'cause we have done all of these things. So they felt like they were way elevated above everybody else. But, you know, we worked... on the Cerenia Pivotal Trial. We were on the Masatib Pivotal Trial. So when they weren't even called that, Serenia had some long, crazy, numbered name associated with it. So to be able to work on those things before they even had a name is actually pretty cool. Because then when you're actually in the room talking to the owner, you could be like, yeah, we were part of this from day one. And to the owner, I think that gives you a lot more credence that they really feel, you know, you have a ton of experience because you worked with this product before it even had a name. 

Dr. Venable: And I think it could give you a competitive edge, right? 

Dr. Clifford: Without question. And that's the other thing in regards to it, you know, that's a great point you brought up that I was going to discuss as well is, you know, for many of us in my area, you know, we had when we came here from New Jersey into PA, you know, we had 18 oncologists in our region. So it was a competitive region. So we needed to do something to kind of showcase ourselves. And to be honest, showing that your hospital has this academic edge is something that does that. I'm not saying it makes me better than anyone, but to an owner, they may see the fact that you do trials as a more positive or view it differently than someone who doesn't.

The other big value that I found with it is like begets like. meaning people who have the same academic edge look for places like that. So we were getting, you know, during a time period where what there's 90 oncology openings, we have people cold calling us to see, are you looking for someone part-time or full-time? 'Cause I'd like to be with you guys because of what you do. So to me, that meant a lot as well. And that's how you get those types of people in your building, and then you just... keep building a team like that. And that's what I've been blessed to have now. 

Dr. Venable: Yeah, it sounds like so many good things from clinical trials, things I hadn't really even thought about in a lot of those realms. So that's exciting. Well, I hope more people are encouraged to maybe try out more trials because I do feel like, and you can tell me your opinion, but the oncology realm, we're actually getting some activity, you know, for so long, there was not much, right? But I can like the last few years, companies are interested. I think they're also seeing this is a realm that maybe you can try it out in dogs to see how well, to help them get approval in people later. So it can kind of help both of us, our dogs and people. 

Dr. Clifford: One health aspect, correct.

Dr. Venable: Yeah, exactly. We're actually on a board together talking about the one health. So since you brought that up, do you want to talk a little bit about it? bit about the cancer registry? Just because I do feel like there's still people that don't know what that is. 

Dr. Clifford: Yeah, I think it's a grassroots organization that's slowly getting there. So, you know, one of the challenges, as you're well aware, that we have is that you know, when we meet with our partners in industry, and we want them to come in to do these trials that we're talking about. From their aspect, you can understand they want to know what is the market. So they say, well, how many lymphomas are seen in a year? And the answer is we have no idea. You know, I can say I see 200, you see, you know, 250, someone sees this, but that's not a real aspect of it. We really don't know. And that makes it difficult to get the partners in the industry to come in because, you know, clearly they have a fiscal responsibility to their company when they're bringing something in and without knowing it's a big leap of faith. So our thought process was multifactorial one within the US, there really is no cancer registry that's available and the thought process by getting this set up And it's called Take Charge Cancer Registry And it was funded and started through Jaguar Animal Health, and disclosure, I'm on their advisory board, as are you, for the foundation and our thought process is to try to get this to gain more information. It's going to take a lot of work because we have to be able to look at all sorts of records, not just records from you and I, because we see a very biased population. We have to be able to get records from everyone. And the hard part is getting the buy -in from all of the different practices because the other challenge that we have certainly in America right now is our information keeping our information safe. We hear all the time about breaks that occur in, what was it, recently, MGM out in Vegas, not too far from you, where everyone's personal information was stolen. And that's a huge thing. 

So many of the big companies, they're worried about us gaining access. So we have the ability to do it anonymously and have the data pulled out and be able to get someone's information. like Banfield or VCA on board, which are, you know, multi-clinics is going to help versus the one small privately owned clinic at a time because that's really where we're going to understand these prevalence and insolence rates and be able to truly understand what's happening. And as you mentioned with the One Health, the other real big aspect is going to be, you know, and that's going to be one of the things that we're going to be able to do. And that's going to be one of the things that we're going to be able to do. some level canary in a coal mine for us. You know, there was some data suggesting out in Oklahoma City, they were seeing a lot of dogs with thyroid cancer. So if we had something like that, where we see a hotspot area of a certain cancer going up, that could be something very important for the aspect in physician-based medicine, because are we going to be seeing the same things? And is this something that we need to look into? So there truly is a one health aspect of it. And we're all doing our best to try to move the cancer registry forward, but it's a wonderful concept. And I can't thank Jaguar enough for helping you and I put it together. 

Dr. Venable: Yeah, it is, I think it's, like you said, a great concept, and I'm hoping to continue to go through, but it is, it's all tough, anything new, right? So, which a lot of times with you doing these trials, you see kind of these new products, and have you seen anything that you were really excited about but just never went anywhere? Have you experienced that?

Dr. Clifford:  I mean, we've definitely had products come through that, you know, have not moved forward. The company elected against them, you know, with working with some companies, we had, you know, a lymphoma vaccine that our data showed was very promising, but it was evidently not. not promising enough where the company decided to move another way. But certainly, of the stuff that's currently ongoing, that is public knowledge that I can speak of. 

We know that we have our first checkpoint inhibitors in veterinary medicine, and there's currently a pivotal trial ongoing with the Merck Gilvetinab. And that is a big one that we're looking at because we know from physician-based oncology, these drugs are the way of the future. You know, the problem that you and I have is with chemotherapy, we can't dose intensify like a person because no owner is going to watch their pet go through it. So we've seen how many studies out there where we tweak a drug this way, tweak a drug this way, give this one first, then give this one. It never changes anything because we can't change the dose intensification. So without being able to do that, chemotherapy is really never going to be the option for us or the end all be all. The idea of harnessing the immune system with these checkpoint inhibitors, that's where we can see. And we know from people with some of them, responses to melanoma and other cancers are in the 40 to 50 % response rates. And we hear of those stories as you brought up where they are truly cured. A person who came in and was told you have months to live, it all went away. So, you know, knowing which patients it's going to be best for, certainly, we're going to find out. But right now, the clinical trial is only for dogs with melanoma. But as you know, once this gets its full approval, what are oncologists going to do? We’ll use it against everything, you know, we're going to try it against all different types of cancer. So, you know, we're certainly, I'm looking forward to that. And it may be that as in people we see we have to use more than one checkpoint inhibitor, we have to to combine them. So that may be where we go next. And it definitely, from the data they've presented, we were part of their pivotal trial as well. 

In people, there's a lot of side effects associated with them immune system-wise. And at least thus far, in the limited number of cases that have been treated and discussed publicly, doesn't seem dogs have the same issue, which is a good thing for a change. So it may be these are better tolerated in them than they are in us. So the hope is, is that to be able to have something like that to offer would be absolutely wonderful. 

Dr. Venable:  Yes, that does sound exciting. I know I'm planning on going to one of the lectures at VCS coming up there. They're going to be lecturing on that because, yeah, I'm wanting to learn more about it. 

You know, and one thing I run into and I'd be curious to your opinion on is sometimes let's say the drugs. that are approved, things that have come through, and now we're trying to figure out how to use them in practice. And sometimes you hear about people combining with different, different drugs, you know, adding multiples together, some people not. How do you recommend to approach that? Because I feel like when I'm in private practice, because a lot of times I would be by myself, you know, you don't want to get left behind, you know, you want to keep up with the current knowledge, but sometimes I would get a little nervous about combining things. I didn't know how it would go. And so, how do you recommend people address those sort of things? Like, do you usually just combine and see what happens, or how do you approach it? 

Dr. Clifford: I think it depends. I think that if there is data from physician-based medicine showing that a combination could work, and this is a cancer that is similar histologically to that in physician-based oncology, it makes sense. The other is if you're truly trying something brand new. you know, the thought processes, instead of just you being the one to do it, you have a group put together, and you come up with a protocol. Everybody follows the same protocol and how you're going to do it. And you come up with 30 cases or so, whatever it is, when you do stats that you're going to do and do it as a study and then publish it and get the information out there because you're right. When you're in private practice, you know, if something's being done at university and it never gets published, you don't know the answer to it and whether those things are going to work. So, you know, we all have a close-knit group of friends, and you know, we have ACVIM, our listserv, that we're all together with. So that's an easy one that if someone was willing to set something forward that, you know, we can all say, "Yes, I'm interested in participating, send it to me." So that's one nice thing we have with our listserv. We're all the oncologists are linked together through ACVIM. If we're interested in trying something new, we're doing something new, we can see maybe someone's already done it before, and maybe they never published it, and they have the data, and you can combine with them or work with them. That's how everything works is by trying to work together. 

Dr. Venable: Working together, that reminds me, listening to a lot of your lectures and webinars, you do a really good job explaining things to the family vet that you know the general practice, and helping them see where they can use different products. And how would you say that you've been able to cultivate that over time? Because I think sometimes there can be sort of this barrier between the specialist and the vet, where we don't want that, but it can certainly happen. But it seems like you've done a really good job blending those. And how would you recommend that for other veterinary oncologists and also just other vets in general, just having more of that team approach? 

Dr. Clifford: Yeah, I mean, I think I've definitely changed that. the way I've lectured in the past five years and that previously I would go and talk about the things that I can do. And here's why you should send the case to me and here's the cool stuff I can do. And I really started to get to the point that I don't really think I was helping primary cares because what's the sense of telling them, just send this to me, and here's what we do when there are many things they could be doing in their clinic.

And the one thing, as you know, know, I always harp on is that many of our diagnostics are veterinary tests. They're not oncologist tests. So there's no reason that they can't be doing them. And it's a way to help the owner because they get more information. First, it helps us because by the time it comes to us, now we have more information. We can do a more streamlined consult with the owner, and it helps the practice because, you know, some of the extra diagnostics may help their revenue, and it gets them more interested in doing these things instead of like, “Oh, God, it's cancer, just go send it.” They see that they can do a lot of these things. 

My favorite lecture that I do right now is “What can I do in primary care?” And I try to list the multiple things that I feel are important for them to be doing that could be beneficial. 

Dr. Venable: And I heard a lot of good feedback from the veterinarians. I think you really enjoyed that. Yeah, I think sometimes it is just trying to break things down and make it practical, and I liked what you said instead of telling them you need to send it to me actually working with them. 'Cause in the end, we all work together, right? It helps everyone. 'Cause like you said, the more information they have coming to see us, the more we can tell people, right? I, you know, every now and then I'd get someone where their dog has a lump and it's like, well, so we need to sample that. I don't know what to tell you. You know? Like the initial consult, this isn't the way I have this framed up. So anyway, yeah, I totally agree.

And I feel like there has been some pushback. I don't know if it's a way of training or if it's because people have gotten so busy. But I have noticed in the last few years where that's aren't wanting to do any work up. You know, have you ran into that too? Or it seems like they just diagnosed cancer and just sort of pushed it away. 

Dr. Clifford: I think it is. depends on the practice and I think you know COVID really hurt a lot of people, you know, all of us were so busy that we don't want to do extra stuff so for many things like that I could see the primary care not wanting to invest the extra time in doing something like that where you know let me just simply move it, move it forward. Plus, there's also always the fear of we live in a very litigious society clearly, and they don't want to overstep bounds by you know doing something that could be come back at them, you know but what we try to do is just in meeting with our primary care we really go through the different cancers and say look these are things you can be doing we're totally cool with it so go for it. there's no reason that you can't so we really try to push a lot of it with them plus for many of our cancers blood workweeks weeks or if it's a week of an oral drug, I like to have them go to the local vet because, you know, local vet's generally going to be closer to primary care doctor. And, you know, it's a disservice if I'm a black hole and everything's done with me and then say the owner calls up and says, you know, fluffy's not acting right. And I just want someone to lay hands on it. It's a big ask for the primary care to jump in when they haven't seen it at all. But if we're seeing the case back and forth, then it's much easier for them to be able to jump in than reach out to us, let us know what they see. 

Dr. Venable: And that's a good point. I hadn't thought about that, but you're right. It probably is pretty intimidating if it has been kind of this black hole, you know, and you don't know what's going on. And then all of a sudden on a Saturday morning, they're coming in to see you. So yeah, that's definitely. 

Dr. Clifford: Yeah, and it furthers them not wanting to do it then because this case came in. And I had. seen it Why would I want to jump into that? But if they've been part of it from the start? I think it makes it much easier.

Dr. Venable: Yeah, that makes a lot of sense, and I do really like the team approach because I think we've seen in the last few years too, there's not enough oncologists, right? Like we just can't see everything. So, however, we can do things together. Of course, now there's debate that there's not enough general vets, but you know, we're all trying to…

There are a lot of vet schools coming through. So hopefully, we'll start to eat into that in a little bit. 

Dr. Venable: Right, exactly. 

Dr. Clifford: They're just getting harder to train oncologists now that there's fewer places that are doing it. 

Dr. Venable: Yes, yeah, it's, how many do you know off the top of your head how many programs there are anymore? 'Cause I know quite a few closed down a few years ago when they changed the regulations. So I don't actually know how many programs there are.

Dr. Clifford: Yeah, most of the private programs. referral clinics are no longer doing it. So right now, to my knowledge, the vast majority, when it was probably 70–30 before, right now the vast majority are all in university. And that's hard because as we know, we all have friends in university, they're having trouble getting people in as well because the challenge we all know is that once we've finished our internship and our residency, we got to pay our student loans off. So it makes it harder staying in academia only because it may not be able to pay at the same level as what we see for you and I in a referral setting. So for many of them, they may not want to embark upon a career in academia, but the problem is the less people that are doing that, the harder it is. And then now we've just recently changed all of our, you know, boarding a process where we don't have to do a paper anymore, which I think also now takes away even less of an impetus to want to do research, which to me makes me worry with that cut down even more people who might have gone to academia, now we're no longer going to do that. So we'll see as time goes by, but if you ask me something that worries me, that might be something that worries me.

Dr. Venable:  If we're gonna keep those academic oncologists and pushing it forward. Yeah, I worry about our vet schools too. It seems like just specialists in general, not even just oncologists, but they're having a hard time keeping people. So, yeah, I'm not quite sure what the answer is gonna be for that. 

Dr. Clifford: Yeah, well, I trained a resident, I did it once, and I don't know if I would do it again 'cause it was very hard to do in a private practice setting. but I did it as best I could, and I did it properly, but it's just not, you know, private practice, you're on the go all the time. So the idea of having time to sit down and really work and hash through a case, you don't always have that ability. So it's, they're two different somewhat mindsets. So maybe I think a hybrid, maybe the next value is that you know, groups that are around the university can maybe split residents. So they get active training from both. That may be what we look at, and that may be the answer to the question. 

Dr. Venable: That's really interesting. I hadn't thought about that with residents. They're doing that more and more with vet students where they are going to different places so they can see more volume, get more hands-on. That's interesting with residents. Yeah, well, yeah, I definitely have to stay tuned, and see what happens. 

Dr. Clifford: See where it goes, exactly. exactly. 

Dr. Venable: And one thing, a lot of times I asked this in the beginning, but with you, I wanted to dive into the Australian part, but what got you into oncology, to begin with? 

Dr. Clifford: Yeah, I mean, I think, I mean, like you and like most of us, I knew I wanted to be a vet early on, so that was a given, which was interesting because my parents were not animal lovers, my dad was a CPA, my mom was, you know, she worked at a GI office. And both my brothers are attorneys. So there was nothing, you know, nothing was just me. So I was the oddball who was in love with animals. And oncology always struck me as, you know, an area that was going to go the most leaps and bounds. 

You know, I tease my friends that are surgeons. How many ways can you, can you fix a frickin' cruise ship? You know what I mean? But, like, we're doing gene therapy. We're doing checkpoint inhibitors. changing the immune system, we're gonna be doing CAR-T and dogs on a routine basis. So, you know, there are leaps and bounds as to what happens in oncology. And, you know, I just was very blessed. I had wonderful mentors who helped me tremendously. I thank them on a, every year, a certain time of year, I reach out to all the people who helped me get where I am, and I tell them, "Thank you for getting me there." And I was very blessed. blessed in being at a hybrid practice at Red Bank. I was able to have about 18 people from me go on to either surgical oncology, radiation oncology, or medical oncology. So I have my little family tree out there, and many of them have come back and work with me now. So technically, my boss Christine Mullin was one of my people. So it's great to be able to have someone who you see that's better than you, you know, to be able to see that in someone and now watch them flourish is a, it's a very satisfying feeling.

Dr. Venable: I love how you mentioned the gratitude, you know, how you annually you said you reach out to people. 

Dr. Clifford: Yeah, my mentor and a large group of people who helped me get where I am I always will either call or send an email and just say, just want to say thank you again I wouldn't be here without you. 

Dr. Venable: That's amazing. I’ve been trying to work on being more you know grateful and but I hadn't thought of that. That's a good one.

Dr. Clifford: We all have time periods we go through that are downtime periods in our life and something like that can be can make it all worthwhile. You know it may change their day and if it that little act of kindness from what they had done for me. If that helps them, then wonderful. Great. 

Dr. Venable: That is wonderful. just the small acts of kindness. And that's probably, maybe you didn't mention it, but maybe that's a little bit of why you like oncology, right? 'Cause you're trying to help those poor pet owners, the acts of kindness, I feel like just educating them for so many people helps to calm them down, right? 

Dr. Clifford: Big time. I mean, when I go in, I sit on the floor and I usually sit next to the pet and that's the best thing is when the pet comes over sits next to me looking at the owner. And, you know, I think one of the things biggest things for new people coming out, it's hard because when you first come out, I'm so smart, I've learned so much, I gotta use big words. And the problem is many of the people you're using these big words, if they don't understand what you've gone through, you've completely lost them. So I almost view it as telling a story and telling it a story in a way that the person could have whatever job, completely dissociative of science, but they understand what I'm talking about. and it makes sense to them. So to me that's what I try to do with my consults, and you know, usually I think it helps a lot. Owners always say that was a great story thank you you know I understand this better. And anytime I have an owner say that it makes me feel good because I feel they truly understood everything we went through. 

Dr. Venable: So how I would like to know a little bit more about the story because I feel like that is becoming more and more people are talking about how life is so much of a story and communication with people and stories is better. So when you do the consult, you're saying you're doing it as a story. So do you start by giving kind of background about the cancer, and do you go into testing and everything but as a in a story fashion?

Dr. Clifford: Yep, truly in a story fashion, doing things where you know, break cancer down into three big groups or categories, then talk about that specific disease, how we normally treat it. And then in the end, we bring it back to their pet. pet. So here's where it all fits with your dog. And then I do the exact same thing in my discharges. I end my discharges with the dog's name is Jake back to Jake and then everything in that paragraph is truly related to there. All the previous is more the history for them, just in case something I had gone through didn't click, it's all going to be written down as well. 

Dr. Venable: Oh, that's great. I love that different, you know, way to do it because I do find especially like you said the new grads, it's hard communicating with pet owners, getting them to understand. And I remember there was a few times throughout my training being surprised, some of the words people didn't know 'cause I was, in my mind, thought I was kind of dumbing it down. And then they would say like, what is, I remember I had a guy ask, well, what's GI upset? And I'm like, well, I feel like that's not a doctor word. But, you know, but I've learned to just explain, you know, vomit. Most people know what that is, right? So like, just explaining those words out. So very, very true. 

Dr. Clifford: Yeah, I'll often say it upsets the belly. And I leave it at that. And that's something that is very relatable. And they get. 

Dr. Venable: Yeah, that's a good one. That's very, yeah. It's trying to find how can you make it simply. And I like, I like the story idea. I'll have to try to delve into that, see if I can. 

Dr. Clifford: And that's one of the next things that I want to work on next. And you may be somebody to help us with it. But it's the idea of offering CE to owners. So we would do it in a way that is very understandable, not super high level, but just to give them that basic information. Because as we talked about before we got started, you know, for many owners, it's hard. It's where do I learn about these things? And we all know Dr. Google is not great. And sometimes the Facebook groups are a blessing and a curse. They're not getting the proper information. So if there was a way to offer, you know, continuing education or any type of education that could be either live or video-based for owners, I think would be a great idea. So that's our next step we're looking to try to do. 

Dr. Venable: Yeah, I like that because you're right, there is so much, they're hungry for it. They're looking for it. But yes, trying to help help steer them into something, one, they understand, because I feel like a lot of the good blog articles that I think are good, probably most pet owners don't understand it, right? And so, yes, trying to get them, it's kind of like, I feel like before Facebook, it was the breeder, you know, like if they would get that information from the breeder, and it's like, oh, well, that's not quite right.

Dr. Clifford: And the hard part with the internet, unfortunately, we try to tell the owners is that, you know, when they type in their pets, can cancer, often some of the things that come up are there because the company paid for their quote-unquote product to be there. It's not that that was up there because it's the best level of medicine or the best level of education. It's there because they paid to be there. And that's unfortunate. So ideally what we'd like is a good reputable source that's out there. That's not going to be super high level, but just to give them something so they have information when they do go in and see either their primary care to talk about it or a specialist, they already have some of this information in. So it makes it easier for the person who's talking with them. 

Dr. Venable: Yeah, no, that's true. If they already have some of that background, then that makes it so much smoother, faster. I feel like you can hit more of like what's truly their goals or their big concerns, if they already have that foundation. So that's really exciting. Yeah, definitely keep me posted. I would certainly be interested in diving into that. 

Dr. Clifford: Awesome. We'll get you on board. 

Dr. Venable: Yeah, yeah, no, that sounds perfect. And, you know, we're gonna unfortunately wrap things up here. We're running out of time, but as we're starting to wrap it up, one last question, which we had actually talked about a little bit. Who would you recommend to be on this podcast next? Who do you think would be a good cancer pioneer?

Dr. Clifford: I mean, definitely, I would think the two names that, you know, come a couple of names come to my head, but, you know, Dr. Bergman and Dr. Thamm both have brought drugs through. So I think one interesting thing would be the idea of how they got started. And they both do very different things. Phil is also a hybrid such as myself. And he does a lot of work with all sorts of clinical trials, not just oncology, but he brought a drug through that we use a product, which is the Oncept melanoma vaccine Dr. Thamm brought Tanovea through. So the idea of understanding the process, why don't we have more drugs, and they'll be able to go through, well, here's what it costs to truly bring a drug through, because I think most oncologists have no idea how much money it actually costs to come through. And then some of the people who really made it possible for all of us, Chand Khanna, David Vail, you know, those people that we all look up to, to find out what, where do they see everything going? What are the things they worry about with having so much experience? Where do they see our future? I think that would be a pretty cool thing to look at and I'd be excited to hear them. 

Dr. Venable: Yeah, those are great people. And I love the idea 'cause you're right, trying to get a drug through, I can't imagine what all is involved and how long that takes. So yeah, those would be really exciting. We'll certainly reach out to those people. And I think today you've mentioned so many great nuggets about how clinical trials can really help your practice and your staff and being grateful and gratitude throughout and really networking. You've really highlighted how important that is throughout your career of networking and just also the different ways to find new products, how to use new products, and want to keep the field moving forward in the right direction? right? Doing the research and I liked your idea of even just doing informal little groups of, well, let's all try treating this way and see what happens. I really like that 'cause I do feel like sometimes you feel a little alone once you finish residency, if you're not with a huge group, it's like, well, what is everyone doing? So I really like that idea. 

Dr. Clifford: One of the things we had created was a Northeastern Veterinary Oncology Group where everyone in the Northeastern Veterinary Oncology Group we all met once a year outside of VCS and that's where we started some of these. And what's great is, you know, Doug had come out, Doug Thamm, who is our new president for VCS, soon to be president for VCS, had been at many of these and he brought up the idea to VCS. Why don't we have some regional VCOGs? And that's exactly where you'll have that. So you'll have a VCOG in your region, all of you can be there. And I think what's great about it is it gives us a chance to see each other outside of VCS. because you know at VCS or ACVIM or big meetings you know I get two seconds with you somebody comes and pulls me away or you get pulled away because you see somebody you went to vet school with and with this it gives us another chance to see each other in a different light and then talk about how we can work together so I think only positive things can come with it and if it's under the auspices of VCS that would be wonderful. 

Dr. Venable: Yeah that is exciting so we'll certainly look out for all that to come. Again, thank you so much for being on this podcast and people can find you at the BluePearl in Malvern, Pennsylvania. Did I say that right, Malvern? 

Dr. Clifford: Got it, perfect. Well done. 

Dr. Venable: Okay, so like I don't have my Midwestern accent pronounced that a little bit off, but thank you so much. I really appreciate it. And I think our listeners are gonna take away so many good things from this talk. Thank you so much. 

Dr. Clifford: Thanks so much for having me honored to be here. You take care.

Dr. Venable: Well, that's it for this episode of the Veterinary Cancer Pioneers Podcast. If you enjoyed this episode and gained valuable insight, we would be so grateful if you could mention our podcast to your friends and colleagues. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.