Leticia Nogueira, PhD, MPH, has been the Scientific Director of Health Services Research in the Surveillance & Health Equity Science department at the American Cancer Society (ACS) since 2017. In addition, she is an NIH Climate and Health Scholar. She has long looked at environmental causes of cancer and the impacts on cancer patients as climate change limits access to treatment. She has won multiple awards and worked in fence-line communities. We shared inspiration about finding overlapping solutions to the problems that beset us – and we bemoaned the difficulties of getting past industry opposition and over bureaucratic hurdles.
This interview has been lightly edited for length and clarity.
JMK: So good to meet you in person, Leticia! And I so much appreciate you taking time to talk to me.
LN: Of course, such an interesting topic. It's my pleasure. Thank you.
JMK: Mostly, I just want to get your perspective and stories. I know that you work with vulnerable populations quite a bit.
LN: Yes, that's right. Disparities, equity, structural racism is a big part of what I do here.
JMK: That is so important. And thank goodness, it's starting to get more attention.
LN: Yes, finally, well deserved and overdue attention.
JMK: Did I understand that you also work with fence-line communities?
LN: Currently, not as much. It's a component of what we do when it comes to exposures, but I would say that from an empirical research standpoint, it’s not as much of the work anymore.
JMK: My first question is how did you get where you are? Is there any story from your childhood or your early training that got you interested in children’s environmental health and vulnerable communities?
LN: I have to say that probably the point in time where it was really this ah-ha moment or this intersection where I had to make a decision was working in the Texas State Health Department.
I worked with cancer for most of my career, and when I worked at the Texas State Health Department, one of my duties was supposed to be doing these cancer-cluster investigations. So if there was a community concern, the job was to talk to neighbors, see if a lot of people around are getting cancer diagnoses. And so very soon after I started the job, there was a case of cluster investigation – the most alarming result was the risk of childhood cancers in this nieghborhood near highly industrialized petrochemical infrastructure. I think that’s really when, in combination with some of the other work I did while in Texas, I saw the true impact the environment around us has on cancer risks, and even on access to cancer care and cancer outcomes.
I had mostly thought about cancer prevention from a molecular standpoint or therapy for cancer treatment standpoint. I realized that the environment has a much larger impact on the cancer outcomes than I had previously realized.
JMK: Was that in Houston? I know there is such a corridor there.
LN: In Houston, and especially in the Houston Ship Channel, there is a great deal of polluting infrastructure, and there is a superfund site. There was one site that was contaminated with dioxin, so there was a lot going on in that community as far as environmental hazards.
JMK: Yes – I think it’s pretty well known – just like Cancer Alley in Louisiana. What cancer diagnoses were you seeing among the children?
LN: We were seeing blood cancers, central nervous system cancers, rhabdomyosarcoma, and ocular cancers.
The biggest realization or lesson learned is just the cruelty of these environmental exposures when it comes to children. What I hadn’t realized previously is that if somebody is going to be impacted by these environmental contaminants, it’s the children who are impacted first. Compared to adults, children have higher metabolism; they drink more water per pound, breathe more air, and have more hand-to-mouth behaviors. There are developmental behaviors that increase exposure to these contaminants. And then of course, their organs are developing, so that you can see horrible things happening when they are exposed to the same level of contamination that adults can be. It was just very sad to see that as a consequence of this careless contamination of the environment, you’re seeing the worst health outcomes show up in children first.
JMK: Of course, I have personal experience with the cruelty of that. It is really terrible that we are experimenting our on our own children, our most vulnerable. I suppose you might have seen birth defects, but you were just looking at the cancer. Is that right?
LN: I started at the Texas Cancer Registry. I started just doing cancer outcomes, but as far as the Texas State Health Department, we also have a birth defect registry, like every state has, and they also did these types of studies. There was a lot of overlap for similar reasons: the developmental stages and window of exposure when people are really susceptible to the hazardous risks that come with this environment.
JMK: Absolutely. With the book project, I'm starting with cancer and then continuing with autism, birth defects, asthma, ADHD, and climate change. It is terrible to see. And there is a way that seeing it is understanding it in a different way. Was that your experience? You can know things from textbooks. But I think it is different when you actually put faces to those numbers.
LN: Exactly. To really witness it is completely different. You can see pictures of Louisiana or the Houston Ship Channel, but to experience it – to see levels of contaminants, to smell them, and to hear the stories from the residents that were concerned – is a completely different experience.
I had read many times about the differences in metabolic rate between adults and children and the behavior and the windows of exposure. But before I started working with these kids’ cancer clusters, it didn’t have the same impact.
Similarly, you mentioned climate change. I was working in Texas, years later – by then, I was directing several state health registries: cancer, childhood lead poisoning, injury, toxicology, occupational health. And that’s when Hurricane Harvey hit. It was not the first time Houston was impacted by a hurricane, but Harvey behaved completely different. No one was prepared for the amount of rain. The hospitals thought they were prepared – everyone had backup generators. But there had never been rain and flooding like that before, so the backup generators flooded.
Nobody could get to treatment, and having a cancer background, it’s very unfortunate, but I had a bird’s eye view of the situation as part of the point and response teams – I was exposed to all the things that were happening when Harvey hit and how misleading it was. They thought they were prepared for climate impacts because they had been impacted before. But it wasn’t the winds – it was the water capacity because warmer air holds more water vapor. So Harvey was a textbook example of a climate-driven disaster. It behaved completely differently, and nobody was prepared for that.
That’s when I shifted gears in my career and working on the intersection between climate change and cancer risks – we’re talking disruption of cancer care to impact of climate change events on survivorship care. If you care about cancer, and I think we both do for very personal reasons, you care about climate change because it impacts every single step in the cancer control continuum, from prevention to diagnosis to treatment to survivorship.
JMK: I had not really thought a lot about that disruption of treatment. I had considered the additional risks when you have that much flooding with the contaminants. I know that was a concern in Houston, right? Because these are petrochemical factories that were flooded. So what's happening to the groundwater? And I didn't see how that story played out.
LN: One of the first studies I did since I joined ACS was to look at impacts of hurricanes on lung cancer survival among those receiving radiation treatment. I saw what happened during Harvey. Imagine you have an aggressive tumor. If you miss even a couple of your radiation treatment appointments, it can make a difference. Everything’s flooded; the radiation team is not there; there is no electricity. You cannot get to the facility. There will be a disruption.
I needed to look from an empirical perspective, to increase awareness, to start a conversation, and then hopefully to find solutions and interventions from emergency preparedness so that we could alleviate some of these impacts.
But as you were saying, when you have a concentration of these petrochemical facilities, they are extremely polluting, some of the worst pollutants that we have ever studied. People like to think it’s contained, that we have these barriers and filters – and then something like Harvey hits, and it spread everywhere, including through neighborhoods that had previously been assumed to be safe from these contaminants. These kind of Environmental Justice (EJ) fence-line communities that we were talking about – around the ship channels in Houston, predominantly Hispanic residents – when something like Harvey hits, it spread everywhere. I relate to this because these contaminants and industrial infrastructure are so widespread are the United States and so under-regulated compared to other countries that even communities that assume they are safe are not. And one example was the train derailment in East Palestine; it was a higher socioeconomic status, white community. You can be unaware just how close these containers are to your house – and just how close you are to being exposed to very acute, very high-level exposure. There was low-level exposure no one was thinking about even before the train derailed. You might seem to be getting away with it – you know, we have these nice things like plastics, and you think that the pollution is over there, and it does not concern me, but that turns out not the case. The more we look into it, the more obvious that becomes.
JMK: Absolutely. And some of these exposures in my daughter's case were not voluntary on our part, but even rich communities can afford to treat their lawns. Rich communities can spray for mosquitoes. It's just as you said, so under-regulated. It's really terrible.
You've had such a rich experience. I can see why Lisa Patel recommended you. You've done a lot and ended up at the American Cancer Society, and I just wonder. Among all the things you have done, is there one thing that you've done that's most important, or of which you're most proud?
LN: I'm always thinking that there is so much work still to be done, that I haven’t taken time to look back and think about what has been done and what has worked.
When I first joined ACS, the hurricane and cancer treatment was the very first study I proposed, and when I said that, people at the meeting started laughing. I think they wondered, did we make a mistake with this hire? It took me some time to convince our research group that this work was feasible and relevant, worthwhile taking a look. And then the study was published. Since then, other researchers at other institutions with other specialties and backgrounds have been reaching out, saying, hey, I read your study, and I am worried about something similar. Can we collaborate? Can we cooperate to evaluate these problems? Maybe that’s one of the things to know – to not give up on a crazy idea like hurricanes and cancer, which when you mention it, people almost do a double-take.
It worked like a seed that was planted. Many other projects and ideas and efforts and interventions came from that one project in a way that I had never dreamed would have come to be.
JMK: That’s wonderful! It is difficult to persist in the face of that kind of doubt. Right? I was just at UCSF’s Herb Needleman lecture this morning, and he's a scientist who was really persecuted for his work by the lead industry. But for you, it was the doubt even within your own group.
LN: Yes, absolutely. And I think because we were talking about fence-line communities and equity, it speaks to this diversity in science that you hear a lot about today. So we know that scientific communities are among the least diverse out there. When you have homogenous groups of people, then the ideas, the perspectives, the solutions, the conclusions, and the connections that are made are very limited. The more you have people who have a diverse set of experiences, who have had to work in non-academic environments, from different perspectives, then the more you have a different understandings and connections that I would never have made if I weren’t outside of academia, in state government. And I think that really limits the impact that our work can have when everyone in the room is thinking along the same lines and being exclusionary and dismissive of other ideas because they do not have the same experience. This is very common – but we are all losing by acting this way.
When the residents of the Louisiana Cancer Alley bring up their concerns about the petrochemical infrastructure and the contaminants increasing their cancer risk, and that is dismissed because they do not have epidemiology training, we are all missing out on lived experience and recognizing that as valuable expertise. It’s a point I hope is changing as we begin to recognize the need for more diverse work in the field.
JMK: That is such an excellent point, and it's very hopeful to see the EJ focus of the Biden Administration, for instance, as I know from conversations in the CHPAC. It seems like that's inflecting a lot of the conversations, which is a good start.
It’s wonderful you've had this experience with the communities. I think it must be difficult. But as you have conversations with parents, communicating about risk from all the toxic exposures that kids have, and especially when those exposures are higher, how do you frame that for parents?
LN: That's a good question because when I started working, there was a lot of training on exactly how you talk to the parents, to the community, to the residents. I couldn’t help but try to listen. I was asking a lot more questions than I was going through the talking points that were provided to me. The talking points that are usually provided or recommended is, there are many things that cause cancer. It's very hard to determine any one cancer diagnosis due to this or that. Sometimes it's random mutation. There are several behavioral factors that contribute to cancer.
Listening to an entire community, looking around, I couldn't say those talking points out loud. I was just listening to the reports of the incidents that never made the news: the flaring, the smells, the nosebleeds, the digestive issues, and the difficulties with food insecurity. And then, I know there is a side of the river where my husband doesn’t go to fish. I think I learned so much more from that interaction because I was more interested in what they had to say than in the talking points that were provided throughout our training.
When questions were asked and I needed to provide a response, I would say things like, this is the contaminant that was identified in this area. This is what the World Health Organization International Agency for Research on Cancer (IARC) have found out, which is the gold standard of summarizing what's known scientifically. This is what they say about this contaminant. This is what the science is thinking right now.
But I'm listening to your concerns. And here are the steps the State Health Department can follow. We can look at the data in this way. We will find these CDC-recommended sites. Then this would be the next step, and that would be the next step, and it would feel very bureaucratic. I didn’t have the answers. I learned a lot more from listening to the residents and parents, than having these almost empty steps that we could follow. But that was the best that we could do, given the job or the institution that I was in, at the Texas State Health Department.
At ACS, I rarely ever interact with the patients. It's because it's more focused on the empirical research. We have this huge database that is more far removed.
This is almost a therapy session! [We both laugh.]
It was very conflicting for me to be talking directly to people and not be able to do something immediately to help. Part of this new job is being one more step removed and still being able to contribute to the body of knowledge that informs the policy decisions and the understanding of the risk.
And on the other side too, I have kept in contact with some of these groups and give the talks and join the panels. I also need to see that the larger more empirical research still matters for daily life and immediate concerns of the people who are impacted. I no longer talk directly to people. None of this is from the ACS. But in my role here, I still seek those interactions because it’s like a thermometer – is your work still relevant, still meaningful?
JMK: That's a very humble approach to the work. A lot of people start with the assumption that their work is important. So to even ask that question is awesome. The American Cancer Society, as I am sure you know, has a reputation – Sandra Steingraber is among those who blame the ACS for taking the approach that – we don’t really know what causes cancer and attribute it to personal behaviors, when for decades, there has been a large body of knowledge that has said, well, we do know some of these environmental causes, so why are we not working on prevention? Maybe the ACS has changed, but what is your perspective on that?
LN: Maybe I should stay out of that. Every chance I have to raise this point internally, I do. The decisions on the position that the American Cancer Society takes on this is not up to me. So that’s all I can say about that.
JMK: I get it. I hope to interview some of the people currently working at the EPA, but they can't always talk either.
So, this question is related to the previous one but geared towards parents. There's so much guilt and fear, and of course, I have personally experienced this. Do you tell parents about exposures that, while they're there, they can't do much about -- unless they moved? We had enough resources that we moved away from a busy road to try to protect our children from diesel fumes, but not every family has that. I don't know if you had any thoughts about how you communicate in a way where you are educating, but without raising too much anxiety for parents.
LN: It’s a good question – which comes up a lot – a guiding point of the work I do. When it comes to these concerns about exposure to carcinogens, it comes down again to what we can do. It’s almost cruel to put the burden on the individual to do something, right? A house near a busy road may be the only place you can afford to live. Or it may be water contaminated by lead or forever chemicals. Or maybe families can only afford to feed their children ultra-processed foods that may also be a cancer risk. It’s already overwhelming to be a parent. You’re always worried, and you are always feeling like you are failing. And to add one additional layer of guilt and burden is not helpful for anybody.
And so my approach is to imagine the problem like an onion. First you have the individual, then the family, then the community, then the institutions, then the policy. We should address this on a higher level. It shouldn't be on the individual parent to test 10,000 filters to see which one of them they might need to filter water contaminants so they can protect the health of their children. It should be on the policy level to regulate these chemicals. When we can contribute to the body of knowledge to enable support of regulation – that’s the opportunity I jump at. If there's an opportunity to shift from our reliance on highways or if we can better regulate diesel emissions, that is a much more impactful and honest intervention rather than telling parents not to live here. Even the recent example of electric school buses is such a no-brainer if you are worried about protecting kids. We don’t want kids breathing those diesel fumes. We don’t want parents to be obsessing about, how did I mess up? How am I going to protect my kids? There is still a random component to these things, and it is less helpful than identifying actions that have a bigger impact, beyond my own family.
JMK: Absolutely. I remember, even before my daughter got cancer, we tried to eat organic. At that time, it wasn't clear how much it was protective for an individual from pesticide residues. But we know we were protecting the farmworkers’ kids.
LN: You would be surprised the responses that I get from people in the health community, when I say that with climate change action, you’re also protecting the kids who live around refineries when you eliminate fossil fuel infrastructure. It’s not just the fuel that is in your car. Sometimes I hear things that almost make me lose hope, but it’s good to talk to somebody like you who also thinks along those lines – that this goes beyond my immediate family.
JMK: All of these crises are opportunities. If we fix climate change, we will clean up a lot of these contaminated neighborhoods.
The next question is about U.S. policy regulating chemicals. You already said they are under-regulated. If you had magic powers to single-handedly redesign the policies regulating chemicals, what would that look like?
LN: There are so many different chemicals. That is a really good question. I can’t help but think – where does it start? It’s astonishing the number of chemicals and contaminants in one generation that we have assumed to be safe and allowed to be produced and distributed, and then we dragged our feet in creating regulation even after the science has proven they are not good for us, for the environment, or anything. It really is almost a paradigm shift in how we approach the problem.
What is our goal when we are producing these things? One clear example is the green revolution, or food production. We said we are going to save the world from hunger and then shifted to a monoculture that is reliant on fertilizers, pesticides, herbicides, transportation, processing – all these external inputs, mostly from fossil fuels. Each one of these steps is impacting our health, including pesticides, antibiotics, emulsifiers, food coloring, and all these chemicals. You can put them in the market by assuming they are safe. So I think the answer to your question would have to be a paradigm shift – recognizing that technocratic solutions did not solve hunger. We can’t assume that chemicals are safe, and before you add a chemical to my kids’ food, the industry needs to be responsible for testing in every way possible.
That would be the beginning of the shift away from the perspective that technology is the solution to everything, that we think we are going to create a machine that is going to solve climate change, or a bacterium that is going to eat plastic. Really, already these solutions were in place, but we became disconnected from them in chasing these fancy technological, chemical solutions that are creating more problems than they are solving. The U.S. should at least be on par with other countries, but what are other countries doing? No – we need to think about the root cause of these problems before we just add more chemicals everywhere. How is it that we are defining something as safe? Does that make sense?
JMK: It makes all the sense in the world, and you know it's so interesting what you said, that we had solutions to this. It's something I argued in my first book – that in some ways we need to return to the past. And some indigenous communities still have those kinds of solutions. In Environmental Legacies of the Copernican Universe, I asked, why is it that we think we can pump plastics into the ocean, into the world, and have no impact? I argue that with the change in cosmology, we went from circles and cycles to a straight-line sort of mentality, and yet our ecologies and our health, our biology works on a cycle. So we cannot continue to do this. Why are we fooled into thinking we can? I think there is an over-prioritization of linear thinking.
LN: I love that. I think, oh my gosh! Where have you been all my life? “Why are you thinking about this linearly?” is something I probably argue with people every week, at least, at work. Yes, if you're thinking about this linearly, you keep doing what you're doing. But clearly, it's not linear; it’s not working, so people will ask me, for example, does climate change cause cancer? And I would say our continued reliance on fossil fuels is the shared root cause of both climate change and cancer. The same greenhouse gases, the same pollution that has contributed to the greenhouse effect also increases cancer.
JMK: People don't see the whole. We have solved a lot of problems by breaking them down into smaller problems.
LN: Yes! Both approaches are helpful. But I'm so glad to hear your perspective because I think there's been over prioritization of the linear thinking, and it did help a lot. But maybe now we're at a point that we really need both to work together to solve the problems that are facing us.
JMK: Yes. That is my argument from a humanistic perspective – that our metaphors are wrong. And you would think, metaphors – what does that have to do with the way the world actually works? But I think they actually do have an influence.
In both of my book projects, I'm addressing a central question, which is this: we know we are poisoning our children, and we know we are destroying the only planet on which life exists, through climate change and ecological degradation, and we know there are solutions that we could adopt, but we are not. Why are we not? Reductively, how can we be so stupid? [We both laugh.] But it’s a real question, and I mean this in an earnest, true way. How is it that we are able to do these things to ourselves without recognizing what we are doing?
LN: This is another reason I love this – because it’s a question I think about a lot. Initially, if I asked something like that, the advice everybody receives is that scientists need to take more communication courses and improve the way they talk about scientific results, that we are doing a terrible job, and we need to communicate better. So my own personal communication style may have changed a little bit.
But my personal conclusion is that yes, definitely, we nerds do need to talk better to people who don’t think in scientific terms daily, but my turning point was when I read The Triumph of Doubt, by David Michaels. It is an excellent book that talks about, yes, we aren’t great communicators, but there is this better-funded and well-motivated counterforce to the scientific evidence that will distort the truth. Part of communicating science will always include some uncertainty. But that uncertainty is being systematically used to cast doubt on the scientific findings.
That understanding – what we are up against – is really important. There are a lot of financial interests to keep doing things the way we are doing things now, which is very detrimental to us and to our wellbeing. And that is what we are up against. This shifted my question away from why are we still doing this –why are we so dumb? There is a very organized and well-funded machinery that has been committed to perpetuating these bad decisions. That helps me not get as frustrated by the push-back and confusion because there is a very strong counter-message that is being perpetuated out there.
JMK: I could not agree more, and I think that the counter message has been largely disguised, so that we don't even realize how strong it is. And yes, you have a lot of company in your answer to that question. Some of the people I'm talking to pretty much say, yep, industry – or campaign finance reform.
LN: Exactly. We need to talk about this more. That understanding helped me get to the next point pertaining to this question, which is, it’s getting harder and harder to do this job. First, people were saying, climate change is not real. Now, some will concede climate change is real, but claim there is nothing we can do about it. But more people are coming to the conclusion that the right thing to do is the right thing for environment, and then also for my own health and my children’s health. You see overlap in the solutions, and this is really where I see a change in the conversation. You start to see climate co-benefits, health co-benefits, which makes people realize that it really does make sense. That’s where we need to move. That’s where I find hope in this work.
JMK: That's awesome. And, by the way, going back to the whole communication style question, I looked at the research on how to communicate, as maybe you have as well, and your approach to ask questions and listen, to let people tell their stories, is a best practice.
LN: That just happened, but I’m glad to hear it. [We both laugh.]
JMK: The next question is forward-looking: what do you think children's environmental health will look like in the year 2050?
LN: Gee -- I don’t do the future. That’s a very good question. Maybe I can tell you what I hope. As we think about the overlap in the solutions, we are starting to realize that, for example, in agriculture, decreasing our reliance on pesticides and fertilizers and antibiotics and emulsifiers improves biodiversity and soil carbon capture and decreases pesticide exposures and all those other things we now know are bad for our health.
I hope that this means we will start shifting in that direction and that there will be less contamination. From the regulatory perspective, from the perspective of personal behavior, and even from a market-demand perspective, the case is similar with some of these other intersections. The agricultural example is one I care a lot about because it is such a horrible, dirty way to produce food. It’s such a lie that industrial agriculture addresses food insecurity. When you look at statistics, it’s only gotten worse.
Similarly, with plastics, it all sounds so convenient. But then, then you realize that all this mindless plastic consumption is contaminating our health, given the new research on microplastics. We were talking about the Ohio train derailment,which was going to be used for plastic production. And none of this is getting recycled.
You have the diesel school buses – it’s becoming very hard to defend that strategy of children riding these old polluting buses because the benefits of replacing them overlap and are so obvious. So my hope for childhood health in 2050 would be similar to what you are saying – we will go back to the solutions we already had. Michael Pollan had a good direction on food that I tell my kids every other day: don’t eat something my grandmother wouldn’t recognize as food.
We need to really go back to the past when we had a lot of solutions. This recognition – that technology is not going to save us – that we cannot just leave this planet – that we are dependent on this planet – is key. A doctor would say if you are in an unhealthy house, it is very likely that your family is going to be unhealthy. We are all in this house that we are making unhealthy – and there is no escaping it. You can be very privileged socially or economically, and it will still impact you. Nobody is safe. This recognition that is becoming very hard to ignore is that the right thing to do is good for us and for the environment. It gives me hope that by 2050, kids will be eating real food and not be exposed to chemicals that are completely unnecessary. This system is making a very small percentage of people very rich while it is making all the rest of us very sick.
JMK: Yes – absolutely. You are reminding me of Pope Francis's Laudato Si’. He talks about our common home, and yes, it is not a healthy one anymore. Well said.
LN: So tell me about what you do. You were talking to students right before we met.
JMK: Yes. I teach at Benedictine University. I have a science background. As an undergrad, I worked in a neurobiology lab for four years, and then I was admitted to med school, but also had been won over by literature, so I earned a PhD at University of Michigan – something completely different. I preserved some science interests, and I was doing interdisciplinary work. And then, especially once my daughter got sick, I came back to my science background, and I earned a Master's in Public Health at my own institution so that I would have credentials to talk about this.
I learned so much from studying environmental health from a public health perspective. And then, I wrote Environmental Legacies of the Copernican Universe, which unites those interests. This next project is my bucket-list book because I want the children impacted by these exposures to have their stories told. And I want to wring people's hearts and at the same time, show we have solutions. We could prevent so many of these illnesses. And, as you said, for all these illnesses, the causes are common. I feel this is the piece of the puzzle I can contribute.
LN: Yes. I absolutely agree that sometimes, increasing awareness is the one thing that can have the biggest impact on people who might not have thought about the issue, which can really make a difference.
JMK: Wonderful. I have been really so grateful to you and to everyone who's given me time and talked to me -- what an amazing community of people all of you are! You're all brilliant and dedicated to the most important thing you possibly could be dedicated to. I really am getting a sense that there's such a community here. And that's another thing I want to share in the book: I think it's heartening that many people are working on these solutions.
LN: You’re right. It's good to hear that because it feels very lonely sometimes, especially like in the meeting I described. You are at an institution with a mission, and then the actions are the exact opposite of the mission. And so it's good to hear you're not alone. And there is a community and growing awareness and understanding of these connections and solutions.
JMK: Absolutely! Is there anything else you would like to ask me?
LN: Well, I feel like I want to talk to you every week now. What would you do next?
JMK: Well this book is the biggie – a two-year project at least. I'm borrowing the methodology of ethnography and talking to people and getting stories, and finding it so rich and gaining so many insights. Mark Miller at UCSF said my next project should be to write a history of the discipline. So maybe by the time I finish with this book, I'll have a couple of others on my list.
LN: I want to read your first book because it immediately speaks to my current struggle, and I cannot wait to read this one. And reach out if there any other opportunities for us to interact because it is so refreshing to talk to you, your background, your story, your commitment, and the way you are channeling your energy and your resources and your expertise. It's so inspiring. Thank you for everything.
JMK: Thank you so much, and I hope to post this interview on my blog. There is a discount code for the book there as well.
LN: Have a great day!
