For Renu Dhanasekaran, MD, PhD, assistant professor of gastroenterology and hepatology, being a physician-scientist isn’t merely a profession. “It’s a calling,” she says. Dhanasekaran began her career as a physician in India, then went back to graduate school at Stanford and earned a PhD in cancer biology. Her lab at Stanford School of Medicine studies the molecular biology of liver cancer, with the goal of identifying novel biomarkers and molecular-targeted therapies for the disease.

Liver cancer is the fastest-rising cause of cancer death in the United States, according to the American Association for Cancer Research. And rates are expected to continue to rise through at least 2030. Risk factors include viral hepatitis B or C, fatty liver disease, and alcohol use. Worldwide, hepatitis B is the most common cause of liver cancer, but thanks to routine vaccination that began in 1982, fewer than 5% of liver cancer cases in the United States are caused by the virus. Obesity and diabetes are part of the reason, but “we’re not talking enough about it,” she says. “It’s an underrecognized issue. Liver cancer can happen to anyone.”

Dhanasekaran chose to be a physician because she wanted to help people. But it was only in medical school that she truly began to understand the “gravity of the profession” — how physicians can change and save lives.

Stanford was a really open community, and I felt very supported by my mentor and my division.” As faculty at the university, she had her own clinic already, but she managed to complete her PhD while maintaining her commitment to her clinic as well as teaching students and residents. “It was very interesting because I was going to early-morning classes with 20-year-olds,” she says. “I had two kids already, and I had so many hats to wear while doing all that. But I think Stanford is unique in that a faculty member is able to pursue a PhD.”

Dhanasekaran’s research is focused on liver cancer for two reasons: There are not many treatment options available for the cancer; and there is stigma around liver cancer because sometimes patients already have alcoholic liver disease or hepatitis C and may be, or have been, IV drug users. Because of the stigma, Dhanasekaran says, there isn’t as much attention or funding for liver cancer as other cancers.

Patients at the Heart of Research

Besides her research, Dhanasekaran runs a liver cancer clinic. This allows her to keep track of how her patients are doing. She says this has been humbling, because her patients often don’t survive past five years. “It’s very disheartening that I don’t have a set of patients I can follow long-term because of this disease. I come back into the lab after clinic and think, We really need to do something about this.” Keeping the science so close to the patients is important to her. “It’s so connected because these are the patients I see,” she says. “They inspire me.”

Dhanasekaran also feels that she learns from her patients, sometimes finding a clue from them that can lead her research in a particular direction. She recalls one patient who had a very aggressive type of liver tumor and was expected to survive only weeks or months. But a month later, the tumor had spontaneously resolved. “I had never seen anything like that,” she says. She explained to the patient how unusual her case was and that she wanted to try to understand why. The patient agreed to enroll in a study, and they determined that her immune system was extremely robust and was able to fight and clear the cancer. “We were able to do the science to show how this might have happened,” says Dhanasekaran. “I continue to follow her.” Her story is now published as a case report.

As a clinical assistant professor, he teaches medical residents and fellows who rotate with him in the thoracic oncology clinic. Along with teaching the basics about proper lung cancer treatment, Myall works to educate the new generation of doctors about holistic care.

“My goal with holistic medicine is to build trust—to let them know that I care,” he says. “It’s a team effort. It’s not me just telling them to do something; it’s about being open and honest and having a dialogue.”

Testing Vital Drugs

That amount of work would be enough for most doctors, but Myall does even more.

On top of his clinical work, Myall has been an investigator for a phase 1 trial on two drugs, afatinib and necitumumab, to see how effective they are in treating patients with a specific type of NSCLC where the gene for epidermal growth factor receptor protein (EGFR) has mutated.

EGFR is a regulatory protein that serves as an on-off switch and helps control cell growth, explains Wakelee, who has worked closely with Myall since his residency. Many times, cancer begins because a regulatory protein is switched on all the time, leading to uncontrolled cell growth and division.

There are oral medications that can turn off mutated proteins like EGFR, but over time the cancer cells may develop secondary mutations that change the way these drugs bind to them, making them resistant to treatment. This is one of the reasons why it’s so important to test the efficacy of new drugs, Wakelee explains.

Myall has been an author on three studies that were published in 2022, which range from a case study on an NSCLC patient who received a novel type of therapy, to an evaluation of 120 NSCLC patients whose cancer spread to other parts of the body, to a comparison of two types of treatments for NSCLC patients with another specific type of gene mutation.

Breakthrough Research

To facilitate and enhance their research, WELL investigators developed a scale that uses quantitative scores to measure and assess participants’ well-being in seven domains: sense of self, positive emotions, social connectedness, resilience, negative emotions and experiences, purpose and personal growth, and physical health.

In 2021, WELL researchers investigated the impacts of the COVID-19 pandemic, climate change, eco-anxiety, access to nature, and air pollution on well-being. Recent and planned publications show how the promise of WELL data may lead to better health and satisfaction with life.

In one paper, using data from WELL Singapore, researchers showed that use of parks and physical activity in a park were associated with higher well-being scores in an urban setting.

“These data suggest that even in urban settings, connecting with nature and spending time in accessible parks can help improve well-being because spending time in parks is often related to increased physical activity,” says Hsing. She also points to data showing that physical activity helps with stress management and was associated with better well-being during the pandemic.

Another study also showed that during the pandemic’s shelter-in-place restrictions, individuals who met physical activity guidelines had lower stress. Inactive participants reported sleeping longer and eating more to cope, while active participants reported using physically active stress management strategies.

Hsing adds that they “also found that individuals who engaged in contemplative practice behaviors, such as meditation and cultivation of self-compassion and compassion for others, experienced better well-being, significantly more resilience and positive emotions, and better management of stress during the pandemic.”

She shares these and other advances in the understanding of the subject through a graduate-level course that she launched in January 2022 at Stanford, “CHPR 242: The Science of Well-being: A Global Perspective,” using data from WELL studies in five countries.

In addition, during summer 2022, Hsing and colleagues launched a “curation” project as the basis for many future communications with the general public. Initially, the project will develop lay language summaries and infographics that define well-being, describe the WELL scale and its seven domains, and outline the scope, objectives, long-term goals, methods, and findings of the WELL study.

William Shomali, MD, clinical assistant professor of hematology, always knew he wanted to be a doctor. As a child growing up in Jordan, it was basically a foregone conclusion. Maybe he was undecided as a toddler, but as soon as high school hit, it was clear that medicine was the choice for him. And medical school in Jordan, similar to the European system, is slightly different from that in the United States, involving an earlier commitment: After high school, students go directly to medical school, where they study for six years, and then they do an extra “rotating internship” before residency. Shomali did an elective in the United States during this time period, and this set him on the path to his work at Stanford as a hematologist and oncologist.

stayed an extra year in Cleveland, serving as a chief resident, with an educational goal of reviving physical examination skills and coaching the house staff to deliver high-quality, evidence-based, and cost-conscious care.

Terrific Mentors

After that, Shomali ended up at Stanford for his fellowship, where he met Jason Gotlib, MD, MS, professor of hematology, who quickly became a trusted mentor. “He’s one of the main reasons why I stayed at Stanford,” Shomali says. “He’s been very, very supportive of me and my career development. He taught me the essentials of clinical investigation and how to develop investigator-initiated clinical trials. He’s one of the best clinical investigators in the country, exceptionally kind and approachable, and we continue to work closely together as a team.”

Gotlib remembers meeting Shomali as a fellow on the inpatient leukemia service and describes him as “a voracious and joyful learner.” He adds, “William modeled the aphorism that what you get out of fellowship is what you put in. He quickly earned the respect of our family of hematology colleagues for his work ethic, collegiality, citizenship, and passion for teaching the gospel of hematology.

leukemia. The other type of cancer he specializes in, MDS, causes patients to have too few blood cells, causing anemia, infections, and/or bleeding (and those can progress to acute leukemia, too).

Shomali’s clinical trial work focuses on novel treatment options for patients suffering from these cancers, including targeted therapies. “There’s an unmet need, and we have room to enhance the current standard of care,” he explains. Gotlib has mentored Shomali through this process as well, passing on “the fundamentals of being a clinical trialist,” as he puts it.

and sees it as part of his own personal mission as well as the larger Stanford mission to pass clinical knowledge on to the next generation. 

And of course he doesn’t work alone. On the clinical and research side, he collaborates with many faculty and staff, including a nurse coordinator, study coordinators, and various others who function as a team. “The hematology division is like family,” Shomali states. “We care for and support each other.”

This has held true during difficult times like the pandemic, with its greater shift to telemedicine, and even during the everyday busyness of normal life. Shomali obviously works hard, but also takes time to relax with his family — if you can call it relaxing. He has two young kids, who, he laughs, keep him and his wife “very busy” with trips to the beach and the park (beyond just the normal business of raising them). He also enjoys working in his new garden.

For his part, Gotlib has found that over the years his work with Shomali has progressed beyond their earlier dynamic. As time goes on, he says, “the roles of mentee-mentor have become more blurred, as I continue to learn a ton from William.” And this learning isn’t all medical: “Most importantly,” Gotlib concludes, “I consider William a good friend and have taken great joy in seeing his professional development and watching him and his wife raise two beautiful kids.”

Ultimately, a portrait of William Shomali is a portrait of an exceptional doctor at work, balancing clinical, educational, and research goals as well as a young family. And he’s always looking to the future. “My focus is on being a thorough clinician and investigator,” he says. “I want to help patients find answers in reaching a diagnosis, offer them state-of-the-art treatment on their medical journeys, and advance the standard of care. In hematology/oncology, many times the standard of care is not enough, and we need to improve on that. I want to be a physician who can offer patients novel therapies that change their lives — that’s what drives me every day.”