Biomarker testing explained; gathering food in the city: Upstate Medical University's HealthLink on Air for Sunday, March 3, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," we learn about a new law that requires health insurers in New York to pay for lifesaving biomarker testing.

Thomas VanderMeer, MD: ... In cancer, biomarkers are molecules that indicate if cancer is present, what abnormality is causing the cancer to grow, how active it is, and how it will respond to different types of treatment. ...

Host Amber Smith: A pair of professors from Syracuse University discuss urban foraging.

Anne Bellows, PhD: ... The idea was, you build urban infrastructure that brings people closer to the outside world, to the rural environment, to understand what food is -- something that is not wrapped in plastic at the store. And to participate in gathering it, as part of a family ritual, like cooking a meal. ...

Host Amber Smith: All that, five ways to treat chronic low back pain, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll learn about the growing popularity of urban foraging.

But first, a new law requires health insurers to pay for biomarker testing, and we'll hear how this will help patients with cancer and other diseases.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

New York Governor Kathy Hochul signed a bill just before Christmas that requires health insurers to cover life-saving cancer biomarker testing, which allows for targeted treatment. To understand more about how this bill will help people, I'm talking with Dr. Thomas VanderMeer, the medical director of the Upstate Cancer Center, and Mr. Michael Davoli, who is the American Cancer Society's senior government relations director for New York. Welcome to you both.

Michael Davoli: Thank you, Amber. Thank you.

Host Amber Smith: Let's begin please with a description of what cancer biomarkers are and how they differ from genetic testing and why this has become important in cancer care. Dr. VanderMeer?

Thomas VanderMeer, MD: There's lots of different kinds of biomarkers, but in general, a biomarker is a test to measure something that's happening in our bodies. In cancer, biomarkers are molecules that indicate if cancer is present, what abnormality is causing the cancer to grow, how active it is, and how it will respond to different types of treatment.

In the past few years, there have been major breakthroughs in our understanding of how cancer works and how to design treatments that target specific molecules and spare the rest of the body the toxicity of conventional chemotherapy. Some biomarker testing is done with blood tests and some requires tissue from a biopsy.

Genetic testing refers to, generally, a blood test that looks at what genetics we're born with. We call that germline testing. That differs from this type of testing, which evaluates the specific molecular alterations in the cancer cell.

Host Amber Smith: So this sounds like it's fairly new. How long has it been that biomarkers have been a tool for cancer care providers?

Thomas VanderMeer, MD: We go back to 2001 when the FDA (Food and Drug Administration) approved the first drug called Gleevec, that is designed to target a specific protein on a cancer cell. This was very new at that time. That drug was incredibly effective against a couple of rare cancers, but the concept was so exciting that the FDA approved it in about two and a half months.

Since then, molecular targets and their biomarkers have been identified in many different cancers with numerous new drugs created to interfere with cancer cell growth. And now there are so many potential molecular targets for treatment that testing is done on a panel of over 300 molecular alterations.

Host Amber Smith: So at this point, which cancers is biomarker testing used in the most?

Thomas VanderMeer, MD: Well, it's increasing. All cancers have, or can have, molecular targets for treatment. They're most commonly seen in non-small cell lung cancer, melanoma, breast and colorectal cancer. But 37 of those 62 anti-cancer drugs launched in the past five years, require bar biomarker testing to determine effectiveness, and increasingly we're finding that these new drugs work against more and more types of cancer.

Host Amber Smith: Do you ever have patients who need this, who need biomarker testing or would benefit from it, but whose insurance companies won't pay for it? Do you see that happen?

Thomas VanderMeer, MD: Oh, definitely. And that's why this is so exciting.

My practice focuses on pancreatic cancer. And the typical policy for insurance companies is that they only cover biomarker testing for patients with metastatic disease. But as a surgeon, I see early-stage pancreatic cancer, and we've had a number of patients where we wanted to get biomarker testing, and we figured out how to do it one way or another. And they received targeted treatment, which would be different than the treatment that they would receive if we didn't know about the specific molecular alteration in their cancer. And we've had patients who had the cancer completely eradicated, and there was none seen on surgical specimen.

Host Amber Smith: Wow. So when you say targeted treatment, can you describe what is meant by targeted treatment and how it compares to, I guess, traditional treatment?

Thomas VanderMeer, MD: Well, traditional chemotherapy agents interfere with cell growth throughout the body. They focus on growth patterns that tend to be more common in cancer cells. But all cells get affected, so there can be significant toxicity. These newer targeted treatments modify specific molecular processes that are unique to cancer cells and interfere with cellular signals that cause cancer cells to grow or limit our own body's immune response to fight the cancer. So as a result, there's much less collateral damage to normal cells because the activity of these drugs is so much more specific and limited.

And with newer targeted treatments coming down the line, they're using the molecular profile of a person's individual cancer to design custom vaccines or to reprogram a patient's own immune cells to kill their cancer.

Host Amber Smith: Mr. Davoli, do I understand correctly that this bill was needed because only about a third of health insurers in New York were paying for biomarker testing?

Michael Davoli: Yeah, that is correct. While all insurance plans in the state cover some biomarker testing for some patients, only around 31% of commercial plans cover what is considered comprehensive testing. And in addition, Medicaid does not cover comprehensive testing either. So Medicaid covers some testing for some patients.

So for example, a commercial plan or Medicaid may cover testing for, say, breast cancer only, but no other cancer. But they also may say we're going to cover it if it's a Stage 3 or Stage 4 diagnosis, but we're not going to cover it for an earlier stage. So comprehensive biomarker testing, which is what this bill would achieve, requires coverage for all testing for all diseases and at all stages when medically appropriate.

Host Amber Smith: You mentioned Medicaid. What about Medicare, for seniors? Does that cover biomarker testing?

Michael Davoli: Yeah, luckily Medicare already covers comprehensive biomarker testing. Since that's governed by the federal government, they established this in law several years ago. But Medicaid, on the other hand, the rules are governed sort of on a state-by-state basis.

And so Medicaid only covers some testing for some patients, similar to the way the commercial market. And in a state like New York, when you've got around 8 million people that are on Medicaid, that is so critically important.

Host Amber Smith: Do you know if biomarker testing is covered in other states?

Michael Davoli: Well, so New York state just became the 13th state in the nation to enact comprehensive biomarker testing. New York joined states like California, Texas, Rhode Island, even Arkansas and Louisiana. So it's a real mix of sort of larger and smaller states that have done this. And I do know that there are efforts underway in all 50 states to establish comprehensive biomarker laws similar to the one we now will have here in New York.

Host Amber Smith: Are you familiar enough with the language of this bill to tell whether, does it account for the advances in biomarker testing that are bound to happen in this field?

Michael Davoli: It does. And and that's one of the exciting things about the bill is it's really a, it's not a cancer bill per se, it's a science bill. It's a pro-science bill that sets out a set of criteria that says if different tests for biomarkers meet these different sets of criteria, then they must be covered. And there's a list of different types of criteria, and as long as the test meets one or more of those sets of criteria, it would be covered.

So for example, if something is an FDA-approved test for that disease, it would be covered. Or if there are national guidelines, set out for a certain type of disease and a test, it would be covered. If there is a Medicare approval already for that type of test, it would be covered. And so a test that, say, didn't exist 10 years ago, or even five years ago, but that is developed in the future, as long as it meets those criteria in the bill, it would be covered.

And a perfect example of this is, as the doctor mentioned, you know, you have individual tests for individual biomarkers that have been going on for 20 years where we've been able to sort of, say, test one biomarker at a time. But increasingly, we have companies that are developing these biomarker tests that are these multi-panel tests that really look for every known biomarker that exists within a patient's own blood sample. And the bill allows for coverage of that, if it's medically appropriate and if it meet one of those standards. So, like I said, it really is a pro-science bill that's going to evolve with the science as it develops moving forward.

Host Amber Smith: Does the bill say anything about whether insurers need to pay for genetic testing to see if a particular cancer gene runs in family members, for instance?

Michael Davoli: That's the one area where there is a lot of confusion. So this bill specifically does not deal with genetic testing and whether or not someone is likely to develop a disease in the future. It is focused exclusively on biomarker testing for the purposes of treatment rather than looking to see if someone is predisposed for cancer. So it does not cover that type of genetic testing for predisposition.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Thomas VanderMeer, the medical director of the Upstate Cancer Center, and Michael Davoli from the American Cancer Society. He's the senior government relations director for New York. We've been talking about a new law in New York requiring health insurers to pay for biomarker testing.

How soon does the bill take effect, and how quickly would patients who need biomarker testing have it covered?

Michael Davoli: So the bill takes effect on Jan. 1, 2025. So it'll be next year. However, we do know that putting this bill in place, a lot of insurance plans are already starting to add this comprehensive testing. So like I mentioned, 31% of commercial plans were not covering comprehensive testing. Well, that does mean that the majority were covering testing already, voluntarily. And so what we believe this is going to do is ensure that everyone's covering it beginning January 1st, but in the meantime, we do believe more and more insurance companies are going to add this coverage benefit because they see the value of it.

And now that they see the law that's on the books, they're going to recognize that they might as well start doing this for the benefit of their patients.

Host Amber Smith: Dr. VanderMeer, can you walk us through how a hypothetical person might learn that they would benefit from biomarker testing?

Thomas VanderMeer, MD: The most common gene panel that's looked at is called FoundationOne. And on their website there's a table that shows, based on what type of cancer, what different molecular alterations there might be, and it even says which drugs are available too,to treat those. There's also guidelines published by the National Comprehensive Cancer Network, for each type of cancer, and so people can get information about that.

Generally, just medical oncologists are very aware of this, that they are really enthusiastic about all these targeted therapies and the rapid growth and their ability to use targeted therapies. So, usually just talking to your medical oncologist will be probably the easiest and best way to do it.

Host Amber Smith: So is this what happens almost immediately after you learn that you have cancer? Is this the next step is to find out whether a biomarker test could help?

Thomas VanderMeer, MD: It hasn't been, because we haven't been able to get it approved. But I think with this bill, especially in the states where it's being enacted, that will increasingly be the case.

Host Amber Smith: So is it like going to a lab for blood work, generally? I know you said sometimes there's a biopsy, but often is it a blood draw, and then you wait a certain amount of time to get the results?

Thomas VanderMeer, MD: There are blood tests. What we find more useful, though, is a test on the biopsy specimen itself, because the alterations are frequently different in the cancer itself compared to what we see in the blood. All cancers are diagnosed with a biopsy. So if it's a solid tumor, like, say, lung cancer, then there's a biopsy of that. But even leukemias, there's a bone marrow biopsy. And so, these tests can be run on any specimen.

Host Amber Smith: Is this a test where the results come back either yes or no, or is there more interpretation needed?

Thomas VanderMeer, MD: The tests come back, and it'll say which molecular alteration is present and give you a lot of specific information about that. And the gene panels are really targeted to what would be actionable in terms of treatment. So they're all set up with a specific goal of identifying changes that would impact treatment.

Host Amber Smith: So is treatment sort of put on hold until you get the results back, or are there certain parts of treatment that you would start ahead of time?

Thomas VanderMeer, MD: Yeah, well we like to get the results back as quickly as possible. It usually takes from the time of the request, the tissue has to be sent out to another lab. Once that lab gets it, it takes about 10 days to get the information back. So it's usually about two weeks. So it depends on the severity of the cancer. If people can wait those two weeks without much harm, then a lot of times we would wait to get that information back.

Increasingly, larger institutions are trying to bring those tests in-house. So that we get the information more quickly.

Host Amber Smith: If a person finds out they have a particular biomarker, does that mean that their children or other family members will have the same biomarker?

Thomas VanderMeer, MD: No. The biomarker on the tumor is typically unique to the tumor. The germline testing, which is what we're born with and is the composition of all of our cells, that is heritable. And so if you take, say, like a BRCA mutation that may be in your gene line. That would be passed on to your children. That runs in your family. That's also going to be present on your tumor cell, most likely, but there may be other changes in the tumor cell that have occurred during your lifetime and have caused that cell to change from a normal cell to a cancer cell. And that's why the most important testing is done on the biopsy specimen itself.

Host Amber Smith: And BRCA, that's the breast cancer gene?

Thomas VanderMeer, MD: Yeah. The BRCA mutation put you at risk for other cancers, too.

Host Amber Smith: Okay. Gotcha.

Now, when this bill passed, there was talk that it was going to help reduce health disparities. Can you explain how?

Thomas VanderMeer, MD: Yeah. Well, the out-of-pocket costs for the most commonly used panel is $3,500. And so, as was mentioned earlier, there's 8 million New Yorkers on Medicaid, and they probably don't have $3,500 to pay for this. So if you think about it, if you don't have access to biomarker testing, then you don't have access to these newer targeted treatments. And so every new advanced drug that comes out is widening health care disparities. Because there's more and more treatments that are unavailable to people in lower socioeconomic groups.

Michael Davoli: When you look at who has access to biomarker testing currently in New York state and as well as nationwide, it's really fascinating. If you are a person of color or if you are lower income, but also if you are from a rural area, or if you get your health care from more of a community center as opposed to an academic center, you are less likely to get access to comprehensive biomarker testing. So, for example, if you get your cancer care, your medical care, from an FQHC (federal qualified health center), maybe they do biomarker testing, but then they need to ship it out to a lab. It takes time. And then it comes back and everything. As opposed to if you are getting your treatment at a academic center where they literally do the biomarker testing right there in-house, and they and run it through their processes, it can speed up that process in order for getting you that care.

As well as, some of the larger cancer centers that have larger endowments and money will often cover the cost of biomarker testing for you as opposed to if you were in a community center where they just simply don't have those resources. So that's why this is so important, that it really kind of levels the playing field and brings everyone up to that comprehensive level.

Host Amber Smith: The Upstate Cancer Center is part of an academic medical center. You used the term FQHC. What is that?

Michael Davoli: So that's a federal qualified health center. So these are the health centers that provide health care for a lot of our lower income folks, our Medicaid patients. They exist in New York City, but a lot of the urban areas across the country, and they provide treatment for millions of patients every single year. And they simply, they're not going to have the type of resources that a place like Upstate Medical would.

Host Amber Smith: Now you both specialize in cancer, I realize, but biomarker testing is being used in other areas of medicine. Does this New York bill address any other diseases besides cancer?

Michael Davoli: That is, again, that's one of the exciting things about this bill is that it's not a cancer bill, per se. It's actually disease agnostic. So, while biomarker testing is primarily being used in the treatment of cancer currently, there's research being done in a whole host of different medical conditions -- everything from mental health issues to heart disease, a lot of different neurological conditions, even Parkinson's and ALS (amyotrophic lateral sclerosis) there's research being done on biomarker testing and how they can be used for the treatment of those diseases.

What this bill explicitly says is, if the science shows that biomarker testing can be used to treat that disease, then it should be covered by the law, and the testing should be covered by your insurance.

Now, for example, just this past spring, a test for preeclampsia (a potentially dangerous complication of pregnancy) was approved by the FDA that would help doctors determine whether or not a patient of theirs needed to go on bed rest at home for a month, or if they needed to come to a hospital and spend potentially a month at the hospital prior to delivering their baby. And so you can imagine the mental and financial cost savings that would be if a patient could do bed rest at home versus having to spend a month in the hospital.

That test was just approved by the FDA back in April and now will be covered by this law because it meets that standard of FDA approved for the purposes of treatment. So that's just one example of how this law is going to go way beyond cancer in the future. As long as there is the medical science that sort of meets those standards laid out in the bill, the test would be covered regardless of what type of disease it is.

Host Amber Smith: Well, that's good to know. I want to thank both of you for making time for this interview.

Thomas VanderMeer, MD: Thank you, Amber.

Michael Davoli: Thank you so much. Thank you, Amber.

Host Amber Smith: My guests have been the medical director of the Upstate Cancer Center, Dr. Thomas VanderMeer, and the American Cancer Society's senior government relations director for New York, Mr. Michael Davoli. I'm Amber Smith for Upstate's "HealthLink on Air."

Edible plants, nuts and flowers grow freely throughout cities -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Collecting wild plants, nuts and flowers that grow freely throughout the city is known as urban foraging. Today I am talking with two professors from Syracuse University about this practice, which seems to be gaining support.

Sudha Raj and Anne Bellows are from the department of nutrition and food studies at SU's Falk College. Dr. Raj is a teaching professor with a doctorate in nutrition science, and Dr. Bellows is a professor of food studies.

Welcome to "HealthLink on Air," both of you.

Anne Bellows, PhD: Thank you. It's great to be here.

Sudha Raj, PhD: Thank you.

Host Amber Smith: First of all, Dr. Bellows, can you give us some background on the Syracuse Urban Food Forest Project?

Anne Bellows, PhD: Yes, thank you. The project started in 2019. It's a collaboration that started between Matt Potteiger from landscape architecture at ESF (SUNY College of Environmental Science and Forestry), Stew Diemont from environmental biology at ESF, and myself.

There were these internal grants available at the time from both institutions, and for the first time, they were actually linked, so we had the opportunity to write one proposal and bring it to our separate institutions. And the institutions knew that this was a possibility. This was actually the first time that this had been done, but I am based in food studies, and it developed as an interdisciplinary project.

We work very closely with the city government and local community groups. We were really fortunate that Sudha Raj joined our group after a year, and that's how we started.

Host Amber Smith: Now you and some colleagues from the College of Environmental Science and Forestry have a paper in the journal Nutrients that makes the point that we consume relatively few fruits and vegetables and whole grains and dairy, and way too many refined grains and foods with added sugars, saturated fats and high levels of sodium.

So in general, our collective diet is missing out on nutrition, and you're attempting to find alternate forms of high-quality, local, low- or no-cost food sources. Is that right?

Anne Bellows, PhD: That is right. The project itself started with the idea of having a transect, a riparian transect. That means a pathway along a river area on the South Side of Syracuse.

It runs from about Corcoran High School through Elmwood Park, goes underground -- this is the Furnace Brook. Furnace Brook goes underground -- until it hits Onondaga Creek and then goes north. And our initial transect was up to the Southwest Community Learning Farm, also includes Brady Farm to the south.

It's longer now. It goes from Onondaga Community College all the way to the lake (Onondaga Lake), so it's more like 12 to 15 miles long now, following sort of this transect of public spaces, parks, public land that is not in parks, land bank, vacant lots, et cetera. But the purpose is to identify existing, forageable foods.

And also we have grants now to plant a lot of forageable foods, but it's not just for humans, it's also for more than humans. So we're very interested in the eco-services, the ecosystem services, that benefit, we say, "more than humans," so animals, plants, the ecological infrastructure, especially on the South Side, where there is a level of, sometimes it's called canopy injustice, sometimes it's called environmental injustice, where there is much less greening. And that takes a heavy toll on human and non-human lives. It has to do with environmental quality and community well-being.

Host Amber Smith: So you and your colleagues have traveled this -- what, you said 12 to 15 miles? -- of property and land yourself, kind of looking and seeing what's there?

Anne Bellows, PhD: Yes. The paper that you referred to, in the back, there's an appendix with over a hundred different species, edible species, that we identified, and we've been adding to that, with both native and non-native species that include edible plants and herbs that humans like, but also animals.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Sudha Raj and Dr. Anne Bellows from Syracuse University's Falk College department of nutrition and food studies.

Dr. Raj, what plants did you find growing wild in Syracuse?

Sudha Raj, PhD: It's a host of plants. These include herbs. These include fruits, nuts, vegetables. So all different food groups are represented, and as the paper lists out, all the common plants that have the possibility of growing in this region, or rather they're indigenous to this area, listed out.

Almost every food group category that we, as nutritionists, impress upon people the importance of consuming for optimal nutrient density and for good health outcomes is represented in this tract.

And hopefully all of them can be planted, going forward.

Host Amber Smith: How do you know the nutritional content of something growing near a river or on the side of a road? How do you know how nutritious it is, or if it's even safe to eat?

Sudha Raj, PhD: Well, our partners at SUNY ESF have that expertise to identify, and professor Bellows also is very knowledgeable in this area.

I come to it from a nutrition perspective. Typically, we would do an analysis in a lab to analyze the nutritional composition of these different varieties of foods or food groups, so whether they're fruits, nuts, vegetables, et cetera.

However, that is time-consuming, and it is labor-intensive. So, for the purposes of this project, because of the wide spectrum of plants that we are dealing with, we went to the USDA's (U.S. Department of Agriculture's) food composition database, which has been around for several years now, several decades, and it is updated, sometimes sporadically. And so, through our research, we identified that there were many plants that were growing in our backyards that do not have an adequate nutritional composition.

So, we had to go looking in different places to identify if somebody else had done these nutritional analyses. Sometimes you have counterparts in the other hemisphere, and they might not necessarily be very similar to the ones that are grown in our region, but that is the closest that we have. This also highlights that there is a need for research because this is a large research gap.

If we don't have the nutritional composition, we are just speculating that these products have these bioactive food components that may be important for our health. So it certainly highlights the need for research in this area.

Host Amber Smith: Let me ask you if there is a definition for what foraging is or what urban food forestry is. Dr. Bellows?

Anne Bellows, PhD: Foraging generally refers to collecting, gathering edible foods from more wild, but also very domesticated locations. You could talk about foraging from a garden that you have in the backyard. You can talk about foraging when you're out in the mountains someplace.

When we talk about urban food systems or forestry, urban food forestry, we use a definition that was developed by Bukowski and (J.F.) Munsell, and Catherine Bukowski is actually an ESF grad. And it basically refers to the use of perennial food-producing plants to improve the sustainability and resilience of urban communities.

There are so many different activities and so many styles of what a forest can be. It can be a single tree. It can be a backyard orchard. It can also be the kind of woodland that you find more natural, say, in Elmwood Park or more specifically situated, planted, for example, in Kirk Park.

So there's a very broad understanding. One of the key pieces is that you're talking about perennial species that tend to require less maintenance than, say, a vegetable garden that you replant every year. That's one way to think about it.

Host Amber Smith: So these are plants that are going to come back year after year ...

Anne Bellows, PhD: Right.

Host Amber Smith: ... but is it legal to go harvest them from public lands for your own consumption?

Anne Bellows, PhD: The laws differ in states. They differ in different municipalities. Syracuse actually has code that says, basically, "Thou shalt not pluck or pick on public land," but we work very closely with the Parks Department, with Community and Business Development, that department, to develop these edible forests on public land and land-bank vacant lots.

And we are actually right now working with the city to try to develop a code that better reflects today.

That old code was really written to sort of separate what a city does and what a rural area does.

We are now thinking about agriculture as something appropriate for cities. When this original code was written, we did not have the idea of urban gardening or urban farms. We did not set aside spaces we are trying to do now in Syracuse to be able to support urban food production. So the whole notion of what an urban food system is and how it functions is very much evolving at this very moment. And your question points to that issue.

With regard to the safety, that's something that is evolving very much also, and it's a very relevant, very important question. It makes it very important to know where the city is putting pesticides, right? It is one of the reasons that many community gardens have raised beds, right? So you're not planting in soils that have concentrated heavy metals. So, the question of safety is something that we are very aware of, we work on, but we also want to establish the idea that the conventional, market-based, highly processed food system has its own kinds of risks.

And so when we talk about risk, we have to talk about balancing risk and thinking about: How do we pay attention to what risks are from water quality, from soil quality, from air pollution quality, which also can be picked up by leaves, and what those concentrations are in conventionally produced agriculture, as well as highly processed and ultra-processed foods.

We have a lot of work to do on our food system, whether it's in urban areas or outside of urban areas, but I certainly welcome that question.

Host Amber Smith: Do you know, are there cities in America, or are there other nations, where urban foraging is more accepted or more common practice?

Anne Bellows, PhD: Well, in the States, Atlanta, Georgia, has the biggest urban food forest, seven square miles, on the south side of town, the Browns Mill area. That's one example.

Before coming to Syracuse University, I worked at Hohenheim University in (Stuttgart) Germany. And there were long alleys that were consciously planted with cherry trees, and it brought people out to walk and to gather. And the idea was, you build urban infrastructure that brings people closer to the outside world, to the rural environment, to understand what food is -- something that is not wrapped in plastic at the store. And to participate in gathering it, as part of a family ritual, like cooking a meal. And it's been wonderful to work with Sudha because she brings this experience in India, which is very, very telling of that intersection of daily life and foraging.

Host Amber Smith: So, Dr. Raj, tell me: If someone is going to embark on urban foraging, how should people deal with the weeds and the plants that they've pulled once they get home?

Sudha Raj, PhD: In our paper we talk about bioactives. And these bioactive compounds are phytochemicals. So the word "phytochemical" means chemicals that are present in plants.

And these plants produce these chemicals as a way to protect themselves from other environmental stress, from predators, et cetera. So these compounds are innate to the plant. When we consume them, we also consume those chemicals. Now, some chemicals have a lot of benefits, like the antioxidant chemicals, which basically can do some free-radical scavenging and keep our disease risks low.

I never say that eating plants is going to completely cure you of a disease, but it can certainly keep it at a much lower risk. Now, having said that, plants also produce many chemicals that are toxic because that's the way they protect themselves from the environmental stress, from predators, et cetera.

So sometimes, if we don't know, unknowingly we may consume certain plants, thinking they're good for us, and therefore we may also ultimately consume those toxic materials. Now, if you look at cultural food practices, many cultures across the globe have been dealing with such kinds of plants, and before botany and zoology and all of these became sciences that people were studying, people were foraging and picking up whatever they thought they could consume.

They consumed it by trial and error. They have identified ways of keeping these toxic compounds low. So to give you a simple example, every morning we drink coffee. Those coffee beans have to be roasted. If we ate the coffee, just without roasting, we would be consuming some of those toxic materials that are present in them.

So same way, there are certain beans that have certain toxic materials. So it's about identifying. Many have been identified, and these we call as "antinutrients." The reason we call them antinutrients is because a bean or a lentil can be a good source of a mineral, but if it has an antinutrient, this material can actually bind to the minerals, making it less bioavailable. So we have methods like soaking, boiling, cooking, all of these methods.

In this processed time in the 21st century, when we have so many different processed foods, people go for convenience, so some of the age-old techniques of fermentation, sprouting, et cetera, they have fallen on the wayside. And therefore it becomes very important that, when we are talking to people about plants, about the ability of these plants to be protective and provide these phytochemicals, we also have to keep in mind that there are many antinutrients, and people should be given the correct advice about handling these foods.

How should they be eaten? So some foods can be eaten raw, some need to be processed. There are people who consume raw diets, raw foods diets. And as a dietitian, it is always a big challenge to talk to these people and impress upon them the importance of cooking, because not all cooking is bad. We cook certain things so that we can eat foods and get the maximal nutritional value of it.

So to answer your question, there are lots of toxic materials that could be found, but it is about identifying them, educating consumers about how to deal with these toxic materials.

Mushrooms, for example: There are 400 varieties of mushrooms. People who pick mushrooms all the time, they know exactly what they're picking, and they're very careful about it. But for somebody who has no clue about mushrooms, and they say, "Well, mushrooms are good," they cannot pick anything from off the ground.

So it's about educating, identifying these materials, and then, educating consumers, creating a database about what are some potential toxic elements that might be present and how do you deal with these products, so that we can keep risks to the minimum.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more about urban foraging from our guests from Syracuse University.

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith.

I'm talking with Dr. Anne Bellows and Dr. Sudha Raj from Syracuse University's Falk College department of nutrition and food studies.

So what you're describing, if a person wanted to start into foraging, it seems a little intimidating, like there's a lot you would need to learn. You can't just go out and start picking, right?

Sudha Raj, PhD: I would think I would be careful. This is where we are hoping that we can learn a little bit more about the indigenous cultures around the Syracuse area, what their familiarity is with these plants, how do they use it, so that we can create a knowledge database on some of these plants so that it can be used for educating purposes.

Our dietitians are constantly educating communities about fruits, vegetables, et cetera. This is another layer added to it, that you can go foraging. It's not as intimidating if you go with somebody who's knowledgeable and who can show you the ropes.

For example, the refugees, the Bhutanese refugee women I know, they go to Onondaga Lake Park, and they're able to pluck many of the greens there that we think of as weeds. But for them, those are important greens, and they identify them because they have seen similar ones growing in their region.

Now, I don't know if they're equal in terms of nutritional composition, what their toxic levels are, but people who are used to foraging, they know what to pick and what not to pick. So they can be good guides in this process, and that's also part of the community building, getting people involved and using their knowledge.

And it's also a practice of cultural humility, appreciating and celebrating the cultures around us and the knowledge that they possess about these foods and encouraging cultural capital. We talk about cultural capital in our paper. It's about recognizing what our region is good for, what our region produces, and in bounty, and how we can use it, and how we can celebrate and appreciate those resources that are just around us.

Host Amber Smith: Now, your paper encourages public and private expansion of urban and rural food forests. How do you envision that that would occur? Dr. Bellows?

Anne Bellows, PhD: Well, there is certainly a lot of open space, underused land, everything from Syracuse University South Campus, all that green area, to many vacant lots and to areas along some of the stream corridors that are mostly in scrub now, but could be changed.

One of the cool things is the city of Syracuse Parks Department, through work of the Forestry Unit and the city arborist, they've been giving trees away. So when we do plantings, we have a grant through the U.S. Department of Ag Forest Service Great Lakes Restoration Initiative to do plantings along the stream corridor in order to stabilize the banks and reduce runoff, and in that way be supportive of a healthier Great Lakes ecosystem.

And we collaborate with the Parks Department, Forestry Department, and we do major plantings twice a year, usually in May and October. And when we've done it, we've had 60 to 80 volunteers. The city works with us, and they do these tree giveaways, so people can take trees home and plant them there. The city has its own master plan. There's an urban forest master plan. It does not have a focus on edible species particularly, but it does focus on the critical importance of expanding canopy and canopy justice.

So the city is very involved in trying to regreen the city, especially in areas where there is a dearth, a relative dearth, of green roadways and parks. So there are many ways that greening and, particularly, food forests can develop.

And there's a lot of interest. We've worked with different city elected officials to expand work along Onondaga Creek, the Kwanzaa Garden, the Southwest Community Learning Farm, along the Creekwalk. And we will be very soon working in the Inner Harbor area.

But there are other groups working on it also. We're not doing it all by any stretch. And we work very closely with the Onondaga Earth Corps, a group that is dedicated to training young folks about environmental careers. So the project is very linked to social justice efforts and working closely with what the community identifies as its priorities, both for where things are planted and what we plant.

Host Amber Smith: Well, along those lines, is there anything that you would want landscape professionals to be doing differently, or could they do better toward this?

Anne Bellows, PhD: It would be great if they would focus on both native species and more edible species. It often depends on what people themselves want and also what they know and recognize as valuable and important.

Some people don't want an apple tree because it attracts bees and their kids are allergic, but then there are other options like, nut trees or berry bushes or, some of the beautiful shrubbery, like elderberry.

Host Amber Smith: Well, I appreciate both of you making time for this interview, Dr. Raj and Dr. Bellows.

Anne Bellows, PhD: Thank you so much for having us.

Sudha Raj, PhD: Thank you.

Host Amber Smith: My guests have been Sudha Raj and Anne Bellows from the department of nutrition and food studies at Syracuse University's Falk College. Dr. Raj is a teaching professor with a doctorate in nutrition science, and Dr. Bellows is a professor of food studies.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. HeeRak Kang from Upstate Medical University. What are the options for treating low back pain?

HeeRak Kang, MD: I always tell my patients that there's generally, with myself or any other provider, there's five things you can really do. One, you can do nothing and you can live with it, which is probably what a lot of patients have done.

Two, you can try conservative measures such as like acupuncture, chiropractor, physical therapy, home exercise program. Three, you can try medications. And I try to explain to them medications do have side effects, and I can list those specific ones for the patients.

Four, you can try injections, and understanding that there's always risk and complication with any kind of intervention.

And five, you can do surgery, understanding the risks and possible complications.

I try to go through those five options mainly because I want to also figure out what they've tried. A lot of times they've said they've tried chiropractor or tried PT (physical therapy,) but they haven't tried acupuncture. Or they've tried some medications but maybe they haven't tried them all. So it's kind of my role to figure out what they haven't tried and see if if it's worth it.

You know, a lot of times herniated disks get better with conservative management. And so, I always recommend to my patients, "You don't have to see me. You don't have to see a physical therapist. You don't have to see a chiropractor. You know, you could sign up for the YMCA and use the therapy pool for the next four weeks and see if that will help."

If they're not in severe debilitating pain, they're not having neurological symptoms, weakness, that kind of strange sensation down their leg. If they're not having bowel or bladder issues, then I absolutely encourage patients to do that.

Host Amber Smith: And, you know, a lot of them actually, they get better. And, it's a win for the patient and for myself. You've been listening to physical medicine and rehabilitation specialist, Dr. HeeRak Kang from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Liana Meffert graduated from medical school last May. She is currently a resident in emergency medicine in Washington, DC. She sent us a poem, "2:23," which captures the drama of an unsuccessful resuscitation and tells us how the true story is never really known.

"2:23"

Bullets are funny things,

that something so small can

hurt so much.

His phone keeps ringing,

hardly heard over the rhythmic thump

of the machine forcing blood

through his heart.

If you ask nicely,

I'll spoil the end for you,

if that's what you want.

The end of the story

is the bullet was never found,

though we hunted for one nestled

in the crest of his clavicle

& other places -- we searched

for an answer to save us all.

His phone keeps ringing:

a second life he's left

hanging on its cradle

above the kitchen sink,

backdrop of peeling wallpaper,

a story, a cord,

wound around a finger.

Here, the pressure's dropping:

his heart a heavy slab of muscle

with no dance.

Attending says it's time to call it

like a promise with an end.

Everyone steps away as

the room eats itself whole.

A towel is placed over his eyes,

heavy blanket over his body,

blood & epi still hanging high.

Someone keeps calling.

The end of the story

is the bullet was never found.

The phone rings:

a plea of a song

we don't dare answer.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," why limiting screen media time for babies is important, and how a pancreas transplant could help some people with diabetes.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.